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The Centre for Conflict Resolution (CCR)

HIV/AIDS and Human Security: An agenda for Africa

The Centre for Conflict Resolution (CCR)

9 – 10 September 2005

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Executive summary

The Centre for Conflict Resolution (CCR) in Cape Town, South Africa, hosted a policy advisory group meeting on the theme Human Security and Africa’s New Leadership to Fight HIV/AIDSat the Hilton Hotel in Addis Ababa, Ethiopia, on 9 and 10 September 2005. The African Union (AU) Commissioner of Social Affairs, Bience Gawanas, and other senior African policymakers from the AU Commission, the Intergovernmental Authority on Development (IGAD) and the United Nations (UN), members of the diplomatic community in Ethiopia, representatives of civil society organisations, academics and development partners were among the participants at the meeting. The objective of the seminar was to consider the links between human security and the HIV/AIDS pandemic in Africa, and the potential role of African leadership in addressing this crisis. The seminar also sought to devise policy recommendations on this issue in collaboration with the AU, in order to assist the development of a human security perspective for Africa’s new governance and security architecture.

The policy advisory group meeting in Addis Ababa was premised on the recognition that, in order to address human security concerns in Africa, it is vital to focus on the HIV/AIDS pandemic currently ravaging the continent. While Africa has faced epidemics in the past, none has had an equivalent impact in terms of the decimation of the productive sectors of society. In 2004, the Joint United Nations Programme on HIV/AIDS (UNAIDS) estimated that 25.4 million African adults and children were living with HIV/AIDS; 3.1 million more infections occurred and 2.3 million Africans died of HIV/AIDS in the same year. Sub-Saharan Africa is currently home to two-thirds of those living with HIV/AIDS and nearly 74 percent of all AIDS-related deaths in the world. The continent is the only region in the world where more women than men are infected with HIV: 57 percent of all HIV-positive people in Africa are women, and, most worrying, women constitute 76 percent of those between the ages of 15 and 24 who are infected with the disease. The number of deaths from AIDS in Africa by 2020 is set to approach the combined number of military and civilian deaths in the two World Wars of the 20th century.

The impact of HIV/AIDS on Africa is already devastating and has widespread social, economic, political, as well as peace and security ramifications. Not only is HIV/AIDS the leading killer of adults in Africa, it is also further entrenching poverty, weakening the productive capacities of countries, overwhelming already over-extended healthcare systems, and threatening both national and continental security. As a result of HIV/AIDS, Africa’s life expectancy has been slashed by 20 years, and its economies are losing billions of dollars annually. With the younger, and hence most productive, sector of African populations being decimated by HIV/AIDS, the pandemic is curtailing socio-economic development on the continent. In response to this crisis, and the fact that continental leadership to date has been patchy and uneven, African leaders have recently attempted to co-ordinate initiatives to combat the pandemic.

Since its creation in 2002, the African Union has laid out a comprehensive framework for managing conflicts in Africa. These initiatives have included efforts to co-ordinate and harmonise a response to the HIV/AIDS crisis. Recognising that HIV/AIDS was a “state of emergency” on the continent, African leaders met in Abuja, Nigeria, in April 2001 to develop strategies to combat this pandemic. African heads of state had already subscribed to the UN Millennium Development Goals (MDGs) of 2000, of which the sixth goal specifically targets the need to combat HIV/AIDS, malaria and other diseases. However, it was clear that a plan also needed to be developed to address the specific issues related to the continental challenge of HIV/AIDS. The outcome of the 2001 summit in Nigeria was the Abuja Declaration and Plan of Action, which, among other goals, committed African leaders to allocate at least 15 percent of their annual budgets to fighting HIV/AIDS, tuberculosis and other infectious diseases.

During the Abuja summit, eight African heads of government formed AIDS Watch Africa (AWA) to co-ordinate, survey and accelerate the implementation of their pledges. Headed by Nigerian president Olusegun Obasanjo, AWA was established to create a platform for HIV/AIDS advocacy, to co-ordinate the efforts of African leaders, and to mobilise resources to achieve these objectives. Another important initiative was the Global Forum on Health and Development, held at the African Union Summit in Maputo in July 2003, which brought together African leaders, UN officials and AIDS experts. In 2004, African leaders agreed to place AWA within the AU’s Department of Social Affairs to implement a strategy for identifying and disseminating “best practices” for HIV/AIDS mitigation on the continent. The AU’s most recent initiative has been the development of an HIV/AIDS Strategic Plan 2005-2007, which is being implemented in partnership with regional economic communities (RECs) such as the Southern African Development Community (SADC); the Economic Community of West African States (ECOWAS); the Economic Community of Central African States (ECCAS); the Intergovernmental Authority on Development; the Arab Maghreb Union (AMU); and external donors. In October 2005, the AU Commission, UNAIDS and the World Health Organisation (WHO) reported that SADC, ECOWAS and ECCAS have also put in place sub-regional HIV/AIDS Strategic Frameworks in order to improve collaboration between national governments.

The September 2005 policy meeting in Addis Ababa sought to examine Africa’s leadership on these issues in order to contribute to the mainstreaming of a holistic response to HIV/AIDS in the work of the AU. The seminar considered how the AU’s structures could best be developed to offer more effective assistance to governments and African regional bodies in fighting the HIV/AIDS pandemic from a human security perspective. The Addis Ababa policy group argued that a “war plan” was necessary to fight the pandemic on the continent. Deliberations and policy recommendations emanating from the seminar centred on how best to mount this attack. In examining the overall impact of HIV/AIDS, the group noted the implications of the disease, both in terms of human security and within the conventional security structures of African militaries.

A recurrent theme emerging from the Addis Ababa seminar was the need to recognise that HIV/AIDS is a symptom of deeper socio-economic and development problems in Africa that must be urgently addressed. Poverty, poor nutritional conditions and underdevelopment are all key factors that contribute to the vulnerability of Africans - particularly young African women - to the pandemic. However, while the disease is devastating households and crippling economies, the lack of comprehensive initiatives aimed at addressing the relationship between poverty, gender inequality and HIV/AIDS are hampering an effective response to the epidemic.

One of the principal challenges in addressing HIV/AIDS is the lack of adequate resources. The AU Commission reports that Africa has only 1.3 percent of the world’s health workforce, while the continent carries 25 percent of the world’s disease burden. Financing is thus needed to ensure that often over-stretched national healthcare systems are more capable of delivering services to AIDS sufferers. To date, the pledge of African leaders at the Abuja meeting in 2001 to devote 15 percent of national budgets to health expenditure has only been met by Botswana. Health spending in Africa ranges from as little as three percent of national budgets in the majority of African countries to 12 percent in South Africa.

However, the provision of more efficient healthcare systems alone is not enough to confront the HIV/AIDS pandemic. Advocacy partnerships are also needed to assist continental structures in developing strategies which adopt a comprehensive approach to the prevention of the spread of HIV/AIDS, as well as promote increased capacity for treatment and care. The AU and civil society should utilise existing funding such as money offered by the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM). Africa receives nearly 60 percent of the Global Fund’s grants, yet the continent is not well represented on the organisation’s structures. African institutions and actors must take initiatives that enhance their role in the Global Fund’s decision-making structures.

Addressing HIV/AIDS in Africa is not simply about increasing resources from donors. There is also an urgent need to be more creative and strategic over how national and continental resources are distributed. Integrating HIV/AIDS mitigation strategies into sectors beyond those concerned exclusively with health - for example, in the areas of development and defence - will greatly enhance attempts to combat the disease. More attention should be placed on how Africa can best mobilise its own resources and use them efficiently, rather than solely on the degree to which the continent can access further financial and technical support from the international community. Furthermore, the funding received from international donors for HIV/AIDS mitigation should be used to respond to African realities rather than to externally-driven agendas. African countries should therefore take responsibility for addressing the HIV/AIDS pandemic and for improving their bargaining skills with the international donor community.

The AU’s challenge, at this juncture, is to provide leadership and ensure the effective oversight of continental strategies to combat HIV/AIDS. The AU Commission’s programmes are intended to accelerate current initiatives, such as the Abuja Declaration, rather than launch new strategies. The AU’s development arm, the New Partnership for Africa’s Development (NEPAD), could be used to promote increased collaboration between continental, subregional and national health services. The AU and NEPAD must provide continental leadership through a transparent monitoring framework to ensure that African health, development, governance and security objectives are achieved.

Ensuring and monitoring “good governance” in Africa is a key factor in countering HIV/AIDS. The African Peer Review Mechanism (APRM) is viewed as critical in this regard. Furthermore, democratic governance is central to ensuring the successful implementation of health policies and HIV/AIDS mitigation strategies. Governments and their constituencies must ensure that rhetoric over the APRM is translated into reality, and that the peer review mechanism facilitates democratic consolidation in Africa. Even though considerable funding has been disbursed to HIV/AIDS, not all these funds have reached their intended beneficiaries. The APRM could potentially be used as a tool to ensure accountability in the fight against HIV/AIDS and offer a means to monitor how governments are investing in the healthcare of their citizens. Governments are not the only actors guilty of misappropriating funds. Civil society organisations should also be subject to similar scrutiny.

The Addis Ababa seminar examined the relationship between HIV/AIDS and human security and Africa’s efforts to keep peace on the continent. The AU has proposed the establishment of an African Standby Force (ASF) by 2010. The force will comprise five brigades from each of Africa’s sub-regions. Most African militaries have in place policies on HIV/AIDS issues, ranging from mandatory testing and voluntary counselling to the provision of treatment. Policies to deal with the HIV/AIDS pandemic are being developed by the RECs, but these organisations have generally failed to co-ordinate their plans with the evolving sub-regional brigades. The establishment of effective policy co-ordination between the proposed ASF sub-regional brigades has also been neglected. It is critical to harmonise HIV/AIDS policies at this level to ensure the ASF’s success in implementing its programmes.

A central approach for the AU effectively to assist in combatting the HIV/AIDS pandemic is through the development and enlargement of capacity on the continent. A recurrent theme at the Addis Ababa seminar was the need to draw on traditional African knowledge and leadership systems which are currently not being sufficiently utilised in devising strategies to fight HIV/AIDS. To transform behaviour and attitudes, indigenous knowledge systems and practices can be a potentially useful resource. However, the policy group disagreed over whether it was best to rely on current traditional structures to help implement mitigation strategies, or to draw more broadly from the positive aspects of traditional knowledge while incorporating these into current HIV/AIDS prevention programmes. The fundamental theme emerging, however, was that the most valuable solutions to combatting the pandemic may be found by drawing on the local context rather than trying to import solutions that have thus far proved ineffective. Since HIV/AIDS is striking at the heart of African communities, the need for a sustained engagement by civil society was identified as critical to empowering people at the grassroots level. The policy advisory group argued for greater transparency in the workings and operations of the AU to enable a fuller engagement by civil society in its work.

The Addis Ababa seminar further provided insights into the links between concepts of human security and continental efforts to manage and mitigate the impact of HIV/AIDS. A number of institutional actors are already taking steps to address human security issues and HIV/AIDS concurrently, and discussions centred on how best to further these developments. The recommendations by actors from research institutions, civil society, the AU Commission, the donor community and UN agencies underscored the desire to share approaches on how best to integrate economic development, peace, security, governance and gender into approaches to address HIV/AIDS on the continent. In summary, the policy group raised seven key policy issues:

  • The scourge of HIV/AIDS in Africa is a symptom of deeper socio-economic and development problems. While the disease is devastating economies, a lack of comprehensive initiatives aimed at addressing the relationship between poverty, gender inequality and HIV are hampering responses to the epidemic. Policies should therefore seek to respond comprehensively to the pandemic through initiatives that go beyond the public health sector.

  • A balance must be struck between issues of state security and human security in order to address HIV/AIDS and other development challenges. Human security does not exclude traditional security threats, and is critical for planning and financing interventions for Africa’s governance, peace and security, and development.

  • The AU’s challenge is to provide leadership on continental strategies on HIV/AIDS. The continental body should focus on accelerating strategies that are already in place, rather than launching new ones. In this way, the AU can add value to HIV/AIDS mitigation strategies by harmonising continental and regional policies with the RECs and civil society. However, the AU will need to be supported in terms of political commitment and the allocation of human and financial resources in order to fulfil this role effectively.

  • Effective co-ordination must be established in policy development among the AU, the RECs, national governments and civil society. The AU and RECs should, in consultation with African civil society, collectively examine and develop policies on a broad range of issues and integrate human security perspectives into the economic, health, development, governance and security sectors. For example, it is necessary to harmonise HIV/AIDS policies for the sub-regional brigades of the African Standby Force.

  • Service delivery optimisation is required to ensure that Africa’s scarce resources are utilised effectively in the prevention and treatment of HIV/AIDS. Policies and funding from international donors should respond to African realities and not to externally-driven agendas; emphasis should also be placed on the extent to which Africa can mobilise its own resources and use them effectively, rather than being too dependent on the international donor community.

  • Advocacy partnerships need to be forged across the private and public sector, civil society organisations, governments and development actors to implement successful strategies that incorporate a comprehensive approach to HIV/AIDS prevention, treatment, care and support. To address HIV/AIDS effectively, particularly in terms of transforming behaviour and attitudes, indigenous knowledge systems and practices can be a potentially useful resource.

  • Addressing “good governance” is key to ensuring the successful implementation of HIV/AIDS polices on the continent. Even though considerable funding has been disbursed to address the pandemic, the reality is that, often, only part of these funds reach their intended beneficiaries. The APRM could potentially be used to make African governments more accountable in addressing the HIV/AIDS pandemic.

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