Time to ask for accountability in Latin America and the Caribbean

none 29 Nov 2006 – 19:04 (modified on 29 Jan 2007 – 14:07)

by mlepeska

There is almost two million people living with HIV in Latin America and the Caribbean, a region that passes by deep technological, political, and philosophical changes boosted by the strengthening of religious fundamentalist sectors. Facing these challenges, the 2006 World AIDS DAY became a great opportunity to highlight that the impact of globalization and of the processes of regional and sub-regional economic integration in the lives of people living with HIV demand the construction of new political paradigms, that should be able to create democratic alternatives based in the human rights. In other words, it is time to ask for accountability and commitment to fight HIV/AIDS.

Because activists in the region believe that the response to HIV/AIDS should not be only a State prerogative, but that it must also come from the communities and people affected by the epidemic, access to treatment and care have greatly increased in recent years. As of June 2006, it was estimated that 345,000 people were receiving antiretrovirals in Latin America in the Caribbean. These represent 75% of those in need, the highest coverage in the developing world. Unfortunately, in spite of greater access to treatment, the numbers of deaths rose from 53,000 to 65,000 in the same period. This means that, on average, 200 people die due to HIV every day in Latin America and the Caribbean.

The community answers have tried and followed the new demands for facing ways to control the pandemic. The vulnerability to HIV infection concept has shown the results of social exclusion structures in the dissemination of HIV, both in cultural prejudices (stigma) and economic and social conditions (access to ARV treatment and new prevention tools.) It requires processes that permanently motivate the strengthening of different social actors and movements. Therefore, the demand for accountability has become particularly essential for Latin America and the Caribbean where the migrations, natural disasters, lack of public policies, state reforms that minimized public health care services, in conjunction with a denial of the epidemic growth, have increased the risk for HIV/AIDS to completely escape controlling actions, whether prevention or universal access to treatment.

There are many problems to overcome in the region. Generally speaking, the PLHAs participation in the planning process is still with lots of difficulties, and the national strategies are still concentrated at the Health State Ministry, more specifically at the National Programmes of HIV/AIDS – NP. Usually no other body of State, i.e. the Education and Labor Ministries, has established and performed relevant strategies and financing plans. Budgets to fight against AIDS continue to be deficient, considering that the budgets for health, in general, are deficient. Mainly it addresses the epidemic in its traditional dimension of public health (prevention, care and support), not including resources to confront discrimination, silence and stigma. The tendency has been national budget reduction and international investment to minimize financial matters. Also, in term of public policies, the NPs do not consider sexual and reproductive rights issues that are related.

Furthermore, the region is still not technologically self-sufficient. The most difficult challenge in relation to the sustainability of the programmes, both of prevention and of HIV/AIDS treatment, are related to technological dependence, which incurs in high costs to the public health programmes. The inclusion of university resources centers of research and cooperation should be an urgent strategy to overcome this dependence barrier. For instance, the so-called “Know Your Status” campaigns were developed by Brazil, El Salvador, Belize, Trinidad and Suriname, but, according to PAHO, only one million people were tested in 28 countries in 2006. Voluntary counseling and testing services has not met the demand yet.

Thus, in many countries civil society mobilization around the World AIDS Day is asking for

accountability as an essential way to demand more consistency between the promises made by governments and their actual performance, at the same time, making clear that it is not necessary to pursue a confrontation between civil society and government, but instead an improvement on this relationship in order to achieve these commitments.

Political will of the government, monitoring/participation of civil society, and assurance of human rights form a basic triad that compose the essential basis for public policies—and its prevention, care, and support services—to become reality. It is possible to create policies to promote health, assure sexual and reproductive rights, improve social protection networks, advance education, and strengthen human rights. All of these themes must be part of State policies, beyond momentary government contingencies, multinational pharmaceutical interests, or fundamentalist views. The path exists. The alternative is viable, but it needs to be collectively built, not only during the World AIDS Day, but also as part of our daily agenda.

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