Global Health: The U.S. and U.N. Response to the AIDS Crisis in Africa
(Statement/Record, 02/24/2000, GAO/T-NSIAD-00-99).

Despite breakthroughs in the prevention and treatment of AIDS, the
epidemic continues to grow in Africa. The broader economic and social
consequences are becoming clear--and they are not good. During the last
decade, the life expectancy in nine African countries fell by more than
17 years because of AIDS. The United Nation's Joint Program on HIV/AIDS
estimates that 42 million African children will lose one or both parents
to AIDS by 2010. In addition, the gross domestic product in many
counties is expected to decline by as much as 20 percent. The countries
in sub-Saharan Africa are among the poorest in the world, and their
ability to respond to the epidemic is limited. At the same time, the
United States and the United Nations have made important contributions
to the fight against AIDS. Research supported by the U.S. Agency for
International Development has helped to identify proven interventions to
help stop the spread of the disease. The U.N.'s Joint Program on
HIV/AIDS has been an important advocate for greater spending on AIDS
programs by national governments, private companies, and donors. The
World Bank, however, estimates that $1 billion is needed annually to
address the epidemic in Africa-more than three times the current level
of spending.

--------------------------- Indexing Terms -----------------------------

 REPORTNUM:  T-NSIAD-00-99
     TITLE:  Global Health: The U.S. and U.N. Response to the AIDS
	     Crisis in Africa
      DATE:  02/24/2000
   SUBJECT:  International organizations
	     Acquired immunodeficiency syndrome
	     Developing countries
	     Health care services
	     Sexually transmitted diseases
	     Health statistics
	     International cooperation
	     Foreign aid programs
IDENTIFIER:  AIDS
	     UN Joint Program on HIV/AIDS
	     Africa

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GAO/T-NSIAD-00-99

GLOBAL HEALTH The U. S. and U. N. Response to the AIDS Crisis in Africa
Statement for the Record by Benjamin F. Nelson, Director, International
Relations and Trade Issues, National Security and International Affairs
Division

United States General Accounting Office

GAO Testimony Before the Subcommittee on African Affairs, Committee

on Foreign Relations, U. S. Senate

For Release on Delivery Expected at 2: 30 p. m., EST Thursday February 24,
2000

GAO/ T- NSIAD- 00- 99 AIDS in Africa 1 Mr. Chairman and Members of the
Subcommittee:

We are pleased to provide our statement for the record, which gives our
observations on the response by the United States and United Nations (U. N.)
to AIDS in Africa. 1 This disease exacts an enormous toll on the developing
world, and on sub- Saharan Africa in particular, where AIDS is a health
problem, a development problem, and a humanitarian tragedy of epic
proportion.

AIDS has killed almost 14 million people around the world, 11 million of
whom lived in sub- Saharan Africa. Two- thirds of the 34 million people who
are currently infected with AIDS live in sub- Saharan Africa, including 1
million children. Despite these alarming statistics and the efforts of the
world community to halt the spread of AIDS, the epidemic continues to
advance (see fig. 1). The World Bank estimates that 16,000 people become
newly infected each day, with the greatest concentration of new infections
in sub- Saharan Africa.

Specifically, this statement will focus on (1) the social and economic
implications of AIDS in Africa and (2) efforts to combat the disease by the
United States and the United Nations. This statement is based on our 1998
report issued to the House Committee on International Relations, HIV/ AIDS:
USAID and U. N. Response to the Epidemic in the Developing World (GAO/
NSIAD- 98- 202, July 27, 1998) and updated information we recently obtained
from the U. S. Agency for International Development (USAID) and the United
Nations on their programs. In our work, we reviewed USAID's and the United
Nations' AIDS programs and activities at their headquarters and in the
Dominican Republic, Honduras, India, the Philippines, and Zambia.

SUMMARY Despite some breakthroughs in treatment and techniques for
preventing AIDS, the epidemic continues to grow. The broader economic and
social consequences are becoming clear- and they are not good. Over the last
decade, the life expectancy in nine African countries declined by over 17
years due to AIDS. By 2010, the United Nation's Joint Program on HIV/ AIDS
(UNAIDS) estimates that 42 million children in Africa will lose one or both
parents to AIDS and that gross domestic product (GDP) in many countries will
decline by as much as 20 percent.

The countries in sub- Saharan Africa are among the poorest in the world and
have a limited capacity to address the epidemic. The United States and the
United Nations have made some important contributions to the fight against
AIDS. USAID supported research that helped to identify interventions proven
to prevent the spread of AIDS and UNAIDS has played an important role as an
advocate for increased spending for AIDS programs by national governments,
private companies, and donors. However, the World Bank estimates that $1
billion a year is needed by the world community to address the epidemic in
Africa- more than three times the current level of spending.

1 The human immunodeficiency virus/ acquired immunodeficiency syndrome or
HIV/ AIDS is referred to in this statement as AIDS.

GAO/ T- NSIAD- 00- 99 AIDS in Africa 2

FIGURE 1 CANNOT BE SHOWN BECAUSE OF ITS COMPLEXITY.

SOCIAL AND ECONOMIC IMPLICATIONS OF AIDS IN AFRICA

The devastating social and economic consequences and human tragedy of AIDS
have not been felt anywhere as

severely as in the countries of sub- Saharan Africa. With only 10 percent of
the world's population, sub- Saharan Africa carries the burden of more than
80 percent of AIDS deaths worldwide, losing 5,500 men, women, and children
each day. Hard- won gains in life expectancy, child survival, education, and
economic development are eroding in many countries on the African continent.
According to the World Bank, the life expectancy in nine African countries
with AIDS infection rates over 10 percent has declined by 17 years, from 64
to 47 years of age. In many countries in the region, infant mortality is
expected to double over the next decade. UNAIDS officials estimate that the
impact on productivity, profitability, and foreign investment will result in
growing losses in GDP, reducing GDP by as much as 20 percent or more in some
sub- Saharan countries by 2010. Barclays' Bank and British Petroleum have
stated that they hire two people for every job, assuming that one will die
of AIDS.

Many African families are overwhelmed by the burden of caring for victims of
the disease. In some parts of the region, pregnant women have extremely high
infection rates- for example, 73 percent of the pregnant women in Beit
Bridge, Zimbabwe are infected with AIDS. According to U. S. Agency for
International Development (USAID) officials, children are forced to become
heads of household, unable to attend school because they must try to find
food for their siblings. Currently, there are approximately 8 million
African AIDS orphans and UNAIDS estimates that 42 million children will lose
one or both parents to AIDS in the next decade (see fig. 2). These children
are at serious risk of physical and sexual abuse as well as other forms of
exploitation, including child labor abuse and organized crime group use as
drug couriers. According to USAID officials, many orphaned children resort
to prostitution for money to buy food. As a result, while many children are
born HIV- negative, their fight for survival puts them at a serious risk of
becoming infected by the disease.

The countries of sub- Saharan Africa are among the poorest countries in the
world and their national capacity to respond to this epidemic is limited.
While they have increasingly demonstrated leadership in fighting the
epidemic, the entire health budget in many countries in sub- Saharan Africa
is about $20 per person each year. In countries where less than half of the
citizens have access to any form of health care, up to 80 percent of the
beds in urban hospitals are filled with AIDS patients. USAID officials
estimate that, on average, countries in Africa are contributing about 5
percent of the cost of their national AIDS programs. But even the most
optimistic experts hope to increase the percentage that national governments
can commit up to 30 percent of the total.

FIGURE 2 CANNOT BE SHOWN BECAUSE OF ITS COMPLEXITY.

U. S. AND U. N. EFFORTS TO COMBAT AIDS Donor nations like the United States
and multilateral organizations like the United Nations are the largest
sources of finance for national- level AIDS programs in Africa,

GAO/ T- NSIAD- 00- 99 AIDS in Africa 3 spending about $300 million a year on
AIDS in Africa. USAID and UNAIDS have made

important contributions to the fight against the epidemic. USAID supported
research that helped identify interventions proven to prevent the spread of
AIDS. USAID's efforts have helped slow the spread of the disease in target
groups such as truck drivers, sex workers, men who have sex with men, and
intravenous drug users. To bolster these efforts, funding for the agency's
AIDS program has increased from $117.5 million per year in 1997 to $200
million in the year 2000 (see fig. 3), and the program has been expanded
from 18 to 52 countries-- 27 of which are in Africa. While primarily
focusing on research and prevention in the 1990s, USAID has extended its
program to include projects that address care for AIDS victims, mother- to-
child transmission, health infrastructure, and support for AIDS orphans. In
addition, USAID is working with the Departments of Defense, Health and Human
Services, and Labor to attack the disease on all fronts.

FIGURE 3 CANNOT BE SHOWN BECAUSE OF ITS COMPLEXITY.

At the United Nations, UNAIDS was established to coordinate the efforts of
U. N. cosponsoring agencies 2 to address the broad range of sociological and
developmental factors that affect the spread of the disease. UNAIDS created
“theme groups” in the field as the forum for coordinating
projects undertaken by the cosponsoring agencies. These theme groups consist
of representatives from all U. N. agencies working in the field on AIDS
projects. UNAIDS officials report that they have also begun to include field
representatives from bilateral donor agencies in the theme groups. UNAIDS
has played an important role in advocacy, attempting to raise the level of
awareness of the problem among national leaders and encouraging additional
spending by donors and the private sector. In addition, UNAIDS has provided
information on the techniques that have been effective in addressing AIDS.
After a difficult start, UNAIDS has undertaken a number of efforts to
improve the coordination of U. N. agencies in the field, and U. N. resources
devoted to AIDS have increased. The United Nations Development Program's
Regional Bureau for Africa recently increased the allocation to its regional
AIDS project based in South Africa by $1 million. The United Nations
Children Fund established 14 additional posts in Africa focused primarily on
prevention programs for young people and the prevention of mother- to- child
AIDS transmission.

The World Bank, one of the cosponsoring agencies of UNAIDS, has increased
its global commitment to AIDS from $28.7 million in 1997 to $391.5 million
in 1999. It has also initiated a significant program devoted to fighting
AIDS in Africa, announcing that it will reexamine all existing African
programs to ensure that they include projects to address AIDS and ensure
that resources can be made available quickly for AIDS projects. However, the
World Bank estimates that a significant increase in global spending is
necessary- at least $1 billion a year- to provide basic prevention and blood
safety programs, to care for people living with AIDS, and to begin to
develop safety nets for AIDS orphans.

2 UNAIDS' cosponsoring agencies include the United Nations Children's Fund;
the United Nations Drug Control Program; the United Nations Development
Program; the United Nations Population Fund; the United Nations Educational,
Scientific and Cultural Organization; the World Health Organization; and the
World Bank.

GAO/ T- NSIAD- 00- 99 AIDS in Africa 4 ----

Mr. Chairman and Members of the Subcommittee, this concludes our statement
for the record. I hope that this information will help the Committee as it
deliberates the focus and size of any foreign assistance directed toward
combating AIDS in Africa.

Contact and Acknowledgments For future contacts regarding this testimony,
please call Ben Nelson at (202) 512- 4128. Lynne Holloway and Tom Zingale
made key contributions to this statement.

(711491)

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