Asia Russell • ACT UP Philadelphia • Health GAP asia@critpath • globaltreatmentaccess • 215 474-9329

1. The IMF, World Bank, and the AIDS crisis Asia Russell • ACT UP Philadelphia • Health GAPasia@critpath.org • www.globaltreatmentaccess.org • 215 474-9329

2. The AIDS crisis is a political crisis that requires political action. 1987: CIA research on the AIDS pandemic anticipates 52 million people infected by 2000. 1992: World Bank on mass death in Africa: “If the only effect of the AIDS epidemic were to reduce the population growth rate, it would increase per capita income growth rate in any plausible economic model.” 2001: UN Secretary General Kofi Annan declares: “There has been a world-wide revolt of public opinion. People no longer accept that the sick and dying, simply because they are poor, should be denied drugs which have transformed the lives of others who are better off.”

4. Donate the Dollars, Treat the People, Drop t he Debt In order to make significant gains in the global AIDS epidemic, ACT UP and Health GAP are working with global allies on 4 fronts: * Demanding lowest cost, quality HIV/AIDS medications— regardless of drug patent status * Demanding the World Bank, IMF and US support full debt cancellation to allow poor countries to have resources to fight the epidemic * Demanding money from wealthy countries to fund effective treatment, care, and prevention programs in hard-hit nations. * Demanding multinational corporations provide treatment to HIV positive workers in cash-poor countries

5. Realities: AIDS death rates drop in the U.S. and other rich countries

6. But life expectancy plummets in Africa.

8. Adults and children estimated to be living with HIV/AIDS as of end 2001 Eastern Europe & Central Asia 1 million Western Europe 550 000 North America 950 000 East Asia & Pacific 1 million North Africa & Middle East 500 000 South & South-East Asia 5.6 million Caribbean 420 000 Sub-Saharan Africa 28.5 million Latin America 1.5 million Australia & New Zealand 15 000 Total: 40 million

9. Estimated number of adults and childrennewly infected with HIV during 2001 Eastern Europe & Central Asia 250 000 Western Europe 30 000 North America 45 000 East Asia & Pacific 270 000 North Africa & Middle East 80 000 South & South-East Asia 700 000 Caribbean 60 000 Sub-Saharan Africa 3.5 million Latin America 140 000 Australia & New Zealand 500 Total: 5 million

10. Estimated adult and child deaths from HIV/AIDS during 2001 Eastern Europe & Central Asia 23 000 Western Europe 8 000 North America 15 000 East Asia & Pacific 35 000 North Africa & Middle East 30 000 South & South-East Asia 400 000 Caribbean 40 000 Sub-Saharan Africa 2.2 million Latin America 60 000 Australia & New Zealand <100 Total: 3 million

11. About 14 000 new HIV infections a day in 2001 • More than 95% are in developing countries • 2000 are in children under 15 years of age • About 12 000 are in persons aged 15 to 49 years, of whom: • almost 50% are women • about 50% are 15–24 year olds

12. “The drugs are where the people are not.”--Dr. Peter Mungyenyi, an AIDS doctor treating people in Kampala

14. IMF and World Bank • International financial institutions that lend money to poor countries in need • Require countries to restructure their economies in ways that devastate social services, health care, and food security in exchange for loans • Many older loans supported corrupt (ex-Zaire) or illegitimate (apartheid South Africa) governments • WB/IMF economic models are based on beliefs: --free markets always pull countries out of poverty --privatizing government services saves money in the long run, with no negative outcomes --tightening the belt is always better than investing money in people

15. Countries ask for relief from the World Bank… …and are told they are too rich to need it.

16. Illegitimate Debt: Africa • Africa’s external debt burden is more than $300 billion • Debt burden and structural adjustment have reversed positive economic and development trends, post-independence • The money has already been written off by the IMF and WB, but nevertheless countries service their debts, and accrue more interest monthly • Debt burden is a massive obstacle to fighting AIDS in Africa • Scant foreign aid goes straight to paying back debts, not for medicines, clinics, schools…

17. Linking Debt, Structural Adjustment, and AIDS • WB/IMF structured poverty increases vulnerability to HIV infection • WB financed projects increase vulnerability • Countries are discouraged from investing money in AIDS treatment and care; not “cost effective” • Health care services privatization has decreased access for the poorest • Structural adjustment erodes life-saving services, crucial to communities responding to AIDS

18. What’s the outcome? • ZAMBIA: more than 4 teachers die daily of AIDS; for every $1 spent on health care, $4 are spent servicing debt. TOTAL DEBT: $6.8 billion • UGANDA: per capita health spending = $2.50 per year, per capita debt servicing = $15.00 per year • ZIMBABWE: 1 in 4 adults have HIV. In the 1980s, Zimbabwe got $500 mn loan from IMF. Social spending was slashed…just as the AIDS epidemic was taking off • IVORY COAST: 1 in 10 adults living with HIV. Before IMF loans, 18% live on <$1/day. Now? 37%.

19. What makes the United States special?

20. How generous is the U.S. in the fight against global AIDS? • U.S. wealth is 40% of the GNP of all donor countries. • The U.S. ranks last among rich countries in assistance measured as percent of GNP.

21. Compare and contrast • Rwanda gives $1 million to Global Fund • US gives $200 million to Global Fund • Making Rwanda more ten times more generous, proportionately