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Nusa Dua, Bali - The stimulus packages, employment generation programmes, poverty alleviation programmes and the social security measures being rolled out across the region to reduce the impact of the global economic crisis should prioritise the urgent needs of HIV-households, said panelists at a symposium on the impact of the financial crisis on people living with HIV and their households at the 9th International Congress on AIDS in Asia and the Pacific here last week.   

People living with HIV and their households are vulnerable to external socio-economic shocks even under normal circumstances and the crisis can affect them severely, they said. The symposium was organized jointly by UNDP, World Bank, Asian Development Bank (ADB) and UNAIDS.

Households of people living with HIV are already in a precarious position. Typically, they have exhausted savings, liquidated assets, and borrowed heavily from friends, moneylenders and others to cope with rising medical costs, and loss of income due to absenteeism or loss of work. Food consumption has declined both in quality and quantity, and education, particularly of the girl child who is pulled out of school to care for sick family members and/or supplement the family income, has been compromised, they said. “HIV positive households are already extremely vulnerable, and added external shocks – either through food security, price fluctuations, or the fallout from the economic crises, could be catastrophic.”

Speaking on the occasion, Dr. Debrework Zewdie, Director, Global HIV/AIDS Program, World Bank, said the overall funding for AIDS globally has increased from $ 4.2 billion in 2003 to $ 13.8 billion in 2008. Yet, there is a gap of 40% between the resource-needs and availability. However, coverage has been much lower than 60%.This points to gross inefficiency. Dr. Zewdie said that financial crisis will suppress aid which would lead to treatment interruptions causing increased mortality and morbidity, among other things. This emphasizes the need for enhanced efficiency in the use of funds.

Dr. Zewdie highlighted a World Bank study on the impact of financial crisis done in 71 countries covering 3.4 million people on treatment which showed that over 50% of countries in the Asia Pacific region would be affected in the next 12 months.
 
Dr. Zewdie said: “There is a need to strengthen efficiency and cost effectiveness, particularly of HIV prevention efforts. There is also a need to develop an early warning system to track and minimize treatment interruptions and monitor the impact of economic crisis on a regular basis.” She emphasized that the key is to enhance efficiency of funds and show results and impact.   

Co-chairing the symposium, Mr. Jeff O’Malley, Director, HIV AIDS practice, UNDP, said there has to be a moral obligation to be efficient in the use of funds. Focus should be on the management systems and in the choice of interventions. He said: “People living with HIV are disproportionately vulnerable and there is a need to make sure social intervention programmes are targeted at the most vulnerable households.”

Dr. Christoph Benn, Director, External Relations, GFATM, allayed fears of shortages of resources at the Global Fund. He said the donors were committed to their earlier promises. He also said that the Fund was sensitive to the allied needs such as food and nutrition that are essential to ARV.

Caitlin Wiesen, HIV Practice Leader for Asia Pacific, UNDP, highlighted some of the core findings of the study, Impact of HIV on Households and Food Security, done by UNDP in Cambodia, Vietnam, China and Thailand and India. She pointed out that HIV affected households had reduced consumption expenditures that they would otherwise make for essential items by 37%. All households below the wealthiest quintile (80% of households) would fall below the poverty line as a result of the income and expenditure effects of HIV.

Detailing some of the policy interventions, Wiesen said: “Poverty and social safety nets need to prioritize HIV households with a range of micro-credit and financing schemes, medical and life insurance and pension support. As seen from experience in Cambodia, food support programmes can be very effective, enabling HIV-infected households to invest in children’s education.” She also emphasized the need for longitudinal studies to provide valuable information on how the household economy changes as HIV progresses over time.

Presenting the voices of people living with HIV who are affected by the downturn,  Mr. G. Pramod Kumar, Senior Program Advisor, UNDP, explained that since the economic crisis of 2008, nearly half of the 400,000 workers in the diamond industry in Surat, India, have been laid off . “The situation of the HIV-infected worker households is precarious with either no food or food reduced by 80% in most households, he said quoting a qualitative study by UNDP in Surat. The situation of those on ART is a major cause for concern.”

Shiba Phurailatpam, Regional Coordinator, APN+ explained that PLHIV in many pockets, particularly working in the export sector, are seriously affected by job cuts due to the impact of financial crisis. This has a serious bearing on treatment and care. On the other hand, there is a real fear that global funds for HIV are also going to be cut. This affects PLHIV directly as funds for treatment in most countries of this region are donor dependent.

Phurailatpam warned that HIV prevention and care services are under-funded and there is no room for further cuts. Social safety nets and stimulus packages should integrate HIV prevention, treatment and care which will help them tide over the situation.

 “Targeting of responses is key,” said Ross Mc Leod, consultant, ADB, in his presentation on sustaining the response during the economic crisis. Leod stressed the need for accurate and timely data, especially for populations, which are the drivers of the Asian epidemics. Containing cost, he said, enhances sustainability.