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VIII. Response of the International Community

Since the start of 2000 the global response to HIV/AIDS pandemic has seen much-needed improvement.  In 2000 the G8 countries acknowledged the need for resources to combat HIV/AIDS, and African leaders confirmed this need for resources in Abuja in 2001.  The United Nations General Assembly Special Session (UNGASS) on HIV/AIDS in 2001 concluded with a firm commitment to create a global fund to fight HIV/AIDS.  World leaders made commitments in the Millennium Development Goals (MDGs) to promote gender equality and empower women (MDG 3) and to combat HIV/AIDS, malaria, and other diseases (MDG 6) by halting and beginning to reverse the spread of HIV by the year 2015.  Significant initiatives have been launched and significant resources mobilized to fight the pandemic and rollout treatment. 

In September 2003 the World Health Organization (WHO) and UNAIDS launched the “3 by 5” initiative, aiming to have three million people in need of HIV treatment on ARVs by the end of 2005.  This included two million people in the African continent, and 1,297 million people in East and Southern Africa.²⁴⁰  In 2003 the US government created the President’s Emergency Plan for AIDS Relief (PEPFAR).  All these initiatives and political commitments enabled countries in the global South with sufficient political will to roll-out HIV treatment.

In 2005 leaders of the G8 pledged to “work with WHO, UNAIDS, and other international bodies to develop and implement a package for HIV prevention, treatment, and care for all those who need it by 2010.”  Member States of the UN endorsed this goal at the High-Level Plenary Meeting of the UNGASS in September 2005.  At the UNGASS High-Level Meeting on AIDS in 2006, the states agreed to work toward the goal of “universal access to comprehensive prevention programs, treatment, care, and support” by the year 2010.²⁴¹

The gender dimensions of HIV/AIDS in Southern Africa, the sub-region most affected by the pandemic, received relatively better attention, thanks, among other factors, to advocacy by women’s NGOs and concerned UN personnel: the former UN special envoy for HIV/AIDS in Africa, Stephen Lewis, and the executive director of the World Food Program, James Morris,²⁴² recommended “urgent action in addressing the gender dimensions of HIV/AIDS in Southern Africa.”²⁴³ In response the former UN Secretary-General established a task force on women, girls and AIDS in Southern Africa to focus on improving the response to HIV/AIDS in nine countries of the sub-region, including Zambia.  The task force focused on six areas, including property and inheritance rights, and violence against women and girls.²⁴⁴

The global political commitments to address HIV/AIDS translated into increased—although not sufficient—financial resources.  In turn, the number of people receiving ART in Africa grew from just 100,000 in 2003, to over one million by December 2006.²⁴⁵  Resources from the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria (Global Fund), PEPFAR, and other bilateral, multilateral, and private donor resources, played a major role in this increase in the number of people receiving treatment. 

The rest of this chapter outlines the role of the two largest contributors to Zambia’s HIV treatment programs, namely the United States (US) government and the Global Fund in responding to some of the abuses described in this report.

The United States

The US government is one of the major donors in Zambia, particularly in the area of HIV/AIDS, including support for HIV treatment programs through PEPFAR.²⁴⁶ Under PEPFAR Zambia received more than US$81.6 million in 2004, about $130.1 million in 2005, and approximately $149 million in 2006 to support HIV/AIDS prevention, treatment and care programs. ²⁴⁷  PEPFAR is providing $216 million in fiscal year 2007.²⁴⁸ Funds are disbursed to “partner organizations” and “sub-partners” and are used to cover a wide range of HIV services and activities.   

In its various documents, the Office of the US Global AIDS Coordinator (OGAC), which coordinates PEPFAR, recognizes the importance of adopting service delivery models that potentially reduce client risk of gender-based violence, and also of supporting interventions that enhance women’s decision-making power in the private and public spheres. ²⁴⁹ However, a number of international AIDS advocacy organizations have criticized PEPFAR’s response to gender-based violence.²⁵⁰

In terms of addressing gender-based violence and other abuses in Zambia, officials in the major US agencies tend to link their program interventions to the White House Women’s Justice and Empowerment Initiative (WJEI).  Announced by the US president in June 2005, WJEI is a $55 million initiative that aims to support ongoing activities to promote women’s empowerment and their access to justice in four African countries, including Zambia.²⁵¹  The initiative is supposed to strengthen the capacity of the legal system so it can protect women through training of the police, prosecutors, and judges in areas of gender-based abuses, including sexual violence.  The initiative also aims to strengthen laws that protect women, such as the Sexual Offences and Gender Violence Bill in Zambia, improve the capacity of shelters, and address women’s health needs.²⁵²  According to the US State Department, “WJEI funds will help raise awareness about gender-based violence, protect and assist victims of rape and domestic violence, and bring justice to perpetrators of violence.”²⁵³

The implementation of WJEI has unfortunately been substantially delayed.  As of November 2007—that is, over two years since the start of the program—no WJEI funds had actually been disbursed for projects in Zambia.  According to the officer in charge of WJEI at the US Department of State, the process of disbursing the funds involved planning, identification of needs on the ground, and ways to complement existing programs.²⁵⁴    

In terms of specific programs addressing gender-based violence and unequal property rights, the second secretary at the US Embassy in Lusaka told Human Rights Watch, “We tend to integrate gender into all of our programs [including in the areas] of justice and legal reform.”²⁵⁵  Potential future areas of support indicated by diplomats at the US Embassy in Lusaka include the establishment of shelters (mainly for victims of trafficking), and establishing additional one-stop centers.²⁵⁶  The US Embassy in Lusaka also has a small grants program. 

PEPFAR Reauthorization and Debates on Prevention and Treatment Approaches

The law that created PEPFAR is up for reauthorization in 2008.  One of the main areas of contention around reauthorization is the allocation of resources in the area of HIV/AIDS prevention.  In 2003 Congress required that 55 percent of PEPFAR money be allocated toward HIV treatment, 15 percent toward palliative care for individuals with HIV/AIDS, 10 percent toward helping orphans and vulnerable children, and 20 percent toward HIV prevention.²⁵⁷  However, at least 33 percent of the prevention funds were earmarked to be spent on abstinence-until-marriage programs, which attracted tremendous criticism from local, regional, and international organizations, including Human Rights Watch.²⁵⁸  PEPFAR’s policies on prevention have been described as “ill informed and ideologically driven.”²⁵⁹

The frustration of Zambian AIDS activists with the US prevention strategies was evident during the visit of US First Lady Laura Bush to Zambia and a number of other African countries in June 2007.  The founder of Health Triangle Trust, which addresses HIV/AIDS, tuberculosis, and malaria, stated that “the good work that the US is doing in providing treatment and care [in Zambia] will come to nothing as long as new infections are not prevented. We are therefore, demanding that the US reconsider its policy on HIV prevention and other reproductive rights issues in order to stop new infections.”²⁶⁰ Abstinence-until-marriage and fidelity programs, stated the Health Triangle Trust, “do not take into consideration the social, cultural and economic contexts that people live in. To simply promote faithfulness without taking into consideration the power play that exist between women and men in [Zambia] is not only ineffective but also puts the women at risk of contracting HIV from their spouses.”²⁶¹

Similarly, the Treatment Advocacy Literacy Campaign (TALC) issued a press statement on the visit of First Lady Laura Bush to Zambia, stating that the conditionalities attached to US government funding for HIV prevention programs were likely to undo the impressive gains made in the area of HIV treatment in Zambia.

The Protection against Transmission of HIV for Women and Youth Act (PATHWAY) bill proposed by Congresswoman Barbara Lee would abolish the requirement to allocate 33 percent of prevention money to abstinence-until-marriage HIV prevention programs.  It also requires the president and OGAC to establish a comprehensive HIV prevention strategy that addresses the vulnerabilities of women and girls to HIV infection in all countries that receive US HIV assistance.²⁶²

Another proposed law, the African Health Capacity Investment Act of 2007, is particularly important in addressing the disastrous lack of capacity in the healthcare system in Zambia and other countries affected by HIV/AIDS in sub-Saharan Africa.  The bill aims to enhance the efforts to achieve internationally recognized goals in the treatment and prevention of HIV/AIDS and other major diseases and the reduction of maternal and child mortality by improving human health care capacity and improving retention of medical health professionals in sub-Saharan Africa.²⁶³  The bill would amend the Foreign Assistance Act of 1961 and authorize the US president to provide assistance for programs to improve health infrastructure and retain healthcare workers in sub-Saharan Africa.  The Act would also direct the US president to develop a strategy to coordinate, implement, and evaluate assistance programs to build the healthcare capacity in Africa.  The Act proposes appropriations of $150 million, $200 million, and $250 million for the fiscal years 2008, 2009, and 2010, respectively.²⁶⁴

The Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria

The Global Fund is one of the main resource providers in Zambia’s HIV sector, including in the area of HIV treatment rollout.  In funding rounds one (2003) and four (2005), the Global Fund approved a total of $322.22 million toward HIV programs in Zambia.  By January 2007 the Global Fund had disbursed $93.10 million of these funds.  However, little of this money covers gender-based violence or gender-specific projects.²⁶⁵ 

The Global Fund has four main recipients in Zambia: the Ministry of Finance and National Planning, the Ministry of Health, Church Health Organizations in Zambia, and Zambia National AIDS Network.  The Global Fund works through a country coordinating mechanism (CCM) in Zambia.  The CCM is responsible for developing national priorities and for overseeing the development and implementation of proposals.  There is no representation of women’s organizations in Zambia’s CCM.