---------- Forwarded message ---------- From: IRIN <[email protected]> Date: Fri, Jul 22, 2016 at 9:02 AM Subject: As AIDS money shrinks, who loses? ... To: ElisabethJanaina <[email protected]>
Today's humanitarian news and analysis *Online version <http://us12.campaign-archive1.com/?u=31c0c755a8105c17c23d89842&id=c0f500e81a&e=399c7ee738>* As AIDS money shrinks, who loses? <http://irinnews.us12.list-manage.com/track/click?u=31c0c755a8105c17c23d89842&id=815e120369&e=399c7ee738> As the global public health community gathered in the South African city of Durban this week to talk about the end of AIDS, they were greeted with news that annual international support for combatting the epidemic had fallen by more than US$1 billion. The news added weight to existing calls for middle-income countries to take more responsibility for funding their own responses. As part of a global strategy to end the epidemic by 2030, representatives from many of the world’s middle-income countries say they are willing to take on that challenge, and with it the opportunity to assume more control in guiding their national programmes. However, there are deep concerns, both among officials and activists. Governments fret that there is not enough time to plan and guide the rapid pace of the transition, which could cause critical services to be interrupted. And civil society groups are concerned that the move to greater dependence on domestic funding will allow administrations that already criminalise specific groups – including gay men and sex workers – to drop HIV services for them entirely. *Less in the pot, less support?* International donor support for HIV responses in low- and middle-income countries fell from $8.6 billion in 2014 to $7.5 billion last year, according to new figures <http://irinnews.us12.list-manage1.com/track/click?u=31c0c755a8105c17c23d89842&id=582faeffc6&e=399c7ee738> released by the Kaiser Family Foundation. The announcement was timed to coincide with the start of the International AIDS Conference, which returned to sub-Saharan Africa this week for the first time in 16 years. There had long been concerns that the funding situation was worsening, but there was widespread surprise that the drop in donor support had been so dramatic. “We came into this conference talking about the risks…from flat funding,” said Dr. Chris Beyrer, president of the International AIDS Society, which organises the annual event. “Then we realized we’re not talking about flat funding, we’re talking about declining funding.” The news was of particular significance for sub-Saharan Africa where more than 70 percent of people with HIV live. Hundreds of thousands of them are dependent on international funding to pay for life-saving treatment. Donor dollars are also being used to avert new infections. The Kaiser analysis underscored a new reality that people living in this region may no longer be able to count on the same level of international support. *Filling the gap and taking back control* In a recent publication <http://irinnews.us12.list-manage.com/track/click?u=31c0c755a8105c17c23d89842&id=b103ca650e&e=399c7ee738> detailing the funding necessary to end the AIDS epidemic by 2030, UNAIDS underscored the need for increased financial commitments from middle-income countries. The specific funding targets it lays out include a 91 percent increase in commitments from lower-middle-income countries, from $4.3 billion in 2014 to $8.2 billion by 2020. Upper-middle-income countries are expected to jump from $9.4 billion in 2014 to $11.3 billion by 2017 – a 20 percent increase. Olive Shisana, a public health researcher in Cape Town, and co-chair of the Durban conference, told IRIN the demand was appropriate. Governments “can reprioritise some of the money that’s going into the military to actually go and save lives,” she said. “I think it’s a realistic call to say, ‘all of us must search deeper in our pockets to get more money to be able to provide HIV services’.” The shift to more domestic funding is already happening. Such funding made up $10.9 billion – or 57 percent of total HIV resources in 2015, according to the Kaiser report. Shisana’s country is at the forefront of that trend. South Africa’s anti-retroviral therapy (ART) programme, the largest in the world, is largely financed by the government. The South African health ministry recently announced that it would further scale up the programme to make treatment available to all South Africans who tested HIV positive – in line with the latest World Health Organisation recommendations. This followed an extensive modelling process to determine what interventions would save the most lives while also being the most cost effective. Mark Blecher, chief director for health and social development at South Africa’s finance ministry, said the decision was also rooted in a perspective of seeing “access to [anti-retroviral medication] almost as a right. We feel so strongly about it that even in a time of economic slowdown, when we have a budget cap, even then, we reprioritise money from other areas”. South Africa’s investment in its treatment programme has given the government control – in collaboration with partners – over how it will achieve its end goal of universal access to ART. And that’s something health officials in other middle-income countries, tired of donors setting priorities, point to as one of the key advantages of increasing domestic financing. *Groups at risk* It also has some experts and activists worried – especially about countries that criminalise some of the groups most in need of HIV services, such as men who have sex with men and sex workers. “In a lot of countries, including South Africa, donors bear a disproportionate financial responsibility for delivering services to key populations, as well as [for] prevention in general,” explained Michael Chaitkin, a programme officer with Results for Development, a non-profit focused on development challenges in low- and middle-income countries. As funding in many of those nations shifts from international to domestic, so will the responsibility for providing services to those populations. If countries choose to deny services, it would raise issues about their basic human rights obligations, while also undermining the broader global effort to end the epidemic. Adding to this concern is that civil society organisations charged with monitoring government responses are also largely dependent on shrinking international donations. It’s unlikely that governments will step in to supplement funding to such groups. “Who wants to pay for the dogs who bite and bark?” pointed out Javier Hourcade Bellocq, an advocate with the International HIV/AIDS Alliance from Argentina. *What to cut, and when?* The funding transition has country officials worried for different reasons. Nduku Kilonzo is the director of Kenya’s National AIDS Control Council. Last year the World Bank re-categorised her country from low income to lower-middle income and she is worried about what that means for the HIV response. Kilonzo told IRIN there has been increasing pressure for the government to up its HIV financing – something she said Nairobi have expressed a willingness to do, but that they need more time. “What would be useful is if we had a plan around how that investment happened, instead of simply: ‘Invest more, invest more,’” she said. Donors’ lack of timelines for withdrawing funding made it difficult for her to approach the finance ministry with a plan for when new funding would be needed. It also increases the risk that, as international donors retreat, programmes could fall through the cracks resulting in treatment disruptions for patients as well as stalled prevention efforts. *Knock-on effects* Despite the concerns about interrupted services, there is a recognition that more domestic financing may not be the only answer. That is the lesson of Botswana – one of the countries to most aggressively pump national resources into its HIV response. It was the first sub-Saharan African country to introduce a national ART programme in 2002. But health ministry official Lesego Mokganya told IRIN the government had committed funds at the expense of other aspects of the health system. “We lost the women we had saved from HIV to abortion when they had unplanned pregnancies because family planning was neglected,” she said. “Or we lost them to cervical cancer because that aspect was neglected.” Now Botswana is turning to foreign donors to help shore up those missing components of the health system, even as the government continues to focus on HIV. Mokganya warned it was a lesson international donors should keep in mind as they push middle-income countries to take financial control of their epidemics. ag/ag/ks *(TOP PHOTO: A community care-giver passes a long line of patients at a rural clinic in South Africa's KwaZulu-Natal Province to pick up anti-retrovrial medication for members of her community treatment group, Greg Lomas/MSF)* *Andrew Green reported from Durban on a fellowship with the **International Reporting Fellowship* <http://irinnews.us12.list-manage.com/track/click?u=31c0c755a8105c17c23d89842&id=9e915fe09e&e=399c7ee738>* (IRP).* hivclinicsalowres.jpg <http://irinnews.us12.list-manage.com/track/click?u=31c0c755a8105c17c23d89842&id=7727e6dbc0&e=399c7ee738> Analysis <http:///analysis> Aid and Policy <http:///aid-and-policy> Health <http:///health> As AIDS money shrinks, who loses? Andrew Green <http:///authors/andrew-green> IRIN <http:///byline/irin> DURBAN <http:///publication-location/durban> Africa <http:///africa> South Africa <http:///africa/southern-africa/south-africa> Global <http:///global> *Read on <http://irinnews.us12.list-manage.com/track/click?u=31c0c755a8105c17c23d89842&id=3a877e5325&e=399c7ee738>* ------------------------------ One man’s terrorist is another man’s carpenter <http://irinnews.us12.list-manage.com/track/click?u=31c0c755a8105c17c23d89842&id=c1e525ae2f&e=399c7ee738> What does a terrorist look like? No such archetype exists of course, but you certainly wouldn’t figure somebody like Mohammed Abdi*. Yet the slight, middle-aged man with a neatly trimmed beard was until 18 months ago a member of the Somali jihadist group al-Shabab – albeit in its finance department. He joined willingly. The former shopkeeper heard a sermon in the mosque in his hometown, 50 kilometres northwest of the central city of Bosaso, urging people to stand up to defend Islam, and was convinced. He handed the keys of his shop to his aunt, and despite the objections of his family, joined the insurgency fighting what he regarded as an illegitimate government backed by Western interests. “I was very excited and very happy as I was serving the religion,” said Abdi. His job was to collect the money raised from al-Shabab checkpoints and the taxes levied once a year on households. When al-Shabab controlled much of the countryside before an offensive last year by the African Union’s intervention force, known as AMISOM, they raised “a lot of money”, he said. It was enough to keep men like Mohammed Farah* armed, fed and fighting. The stocky, gravelly-voiced former al-Shabab soldier had been with the militants from the early days, but now, like Abdi, he has defected. Amnesty and rehabilitation Both men have taken advantage of a government amnesty and are in a voluntary programme for disengaged combatants. These are men and women who are assessed as low-risk by the Somali intelligence service, which means they have not been involved in major military action or committed any serious crimes. "Religion is not one of the main reasons that compels anyone to join al-Shabab" The disarmament, demobilisation and reintegration (DDR) initiative provides them with vocational training, then hires them onto public works projects – typically building schools and clinics – and finally they are set up with a trade and released. Throughout their time on the programme, they live in the community. There are currently three centres: in Mogadishu, south-central Beledweyne, and Baidoa, with a facility in the southern city of Kismayo due to open soon. There is also a safe house in Baidoa for female al-Shabab members and their dependents that graduated its first group of 19 women earlier this year. Somewhere to hide Farah is on the programme, despite his combat experience, because he is a marked man and it’s probably the safest place for him. He was arrested by al-Shabab as a suspected spy after US-piloted drones kept finding his unit, and was lucky to escape what was likely to have been a death sentence. “The only thing that al-Shabab fears are drones and the Ethiopians,” he told IRIN, a reference to Ethiopian soldiers in AMISOM and Ethiopian commandoes camped inside Somalia that report directly to Addis Ababa. A colleague helped Farah get away after he had been beaten up and thrown into detention. He made the 90-kilometre journey to Baidoa barefoot, over terrain he knew well, but he believes he has only delayed the inevitable. He has heard al-Shabab is out to kill him and, even though he sleeps in the barracks, he thinks it’s only a matter of time before they’ll get him. Ideology or religion? Both men said they joined al-Shabab out of conviction. But the evidence for most low-level defectors is that recruitment is driven by economic need, peer pressure, or coercion by family or religious leaders. According to research based on focus group discussions by the UN assistance mission in the country, UNSOM, the main attractions are: the promise of a large salary ($400 to $1,000); the power of the ideology; the cool-looking uniform; the promise of an exciting life; and the attraction of fighting for Islam. “Religion is not one of the main reasons that compels anyone to join al-Shabab,” said Patrick Loots, UNSOM’s chief DDR officer and the architect of the disengaged combatants programme. “On the questionnaire, people listed that they needed money, or that their family needed money,” he told IRIN. “But once in, that’s when al-Shabab works very hard on the religious component.” [image: Suspected al-Shabab] UN Photo/Tobin Jones The bulk of al-Shabab’s recruits are drawn from the central region, and there is little community disapproval over recruitment. “The attitude is ‘these are our sons and daughters’,” said Vikram Parekh, UNSOM’s head of office in Baidoa. “There’s only stigma if you’ve committed something horrendous, and that’s not the people we’re talking about in the disengaged combatants centre.” Disillusionment Abdi and Farah share similar reasons for quitting to take up the government’s amnesty offer. Abdi said he was angered when he realised al-Shabab’s public profession of piety was not the reality. “I saw a lot of vices, like burning people’s property at checkpoints – that is not in the Quran.” But it was witnessing the murder of eight elders accused of collaborating with the government that caused Abdi’s doubts to really set in. “They should have been taken to court, but instead they were taken to a different location and killed,” he told IRIN. “I saw the bodies.” As a soldier, Farah has seen far worse. But it was a similar episode of injustice, and the impunity with which al-Shabab operates, that finally got to him. There was one episode in particular. It was near Beledweyne, when al-Shabab again ordered the execution of an elder. With the knife at his throat, the man started reciting the shahada. “I began weeping,” said Farah. “There was nothing I could do.” Weakness Farah believes al-Shabab is currently at its weakest point. They are paranoid over spies, and, although the movement is historically loyal to al-Qaeda, there is discord over the influence of so-called Islamic State. Being accused of IS sympathies is a dangerous charge to have hanging over one’s head, explained Farah. Al-Shabab is also short of cash. In the past, money allowed them to buy support from the community and provided the intelligence tips that made them so effective. Now, fear of retribution is the main currency. “It’s not human and it’s not Islamic,” insisted Farah. UNSOM’s research suggests the reason low-level al-Shabab combatants defect is that their expectations are not met after they join up. The salary, if paid at all, is between $20 and $500; the discipline is ferocious; and the frontline is far from a glamourous place to be. [image: Liberated town] UN Photo/Tobin Jones Turning things around Abdul Abdulahi* works in one of the government’s rehabilitation centres. He understands the initial appeal of al-Shabab: it was a powerful vision of cleaning Somalia of the clan-based warlords that had destroyed the country, and returning to a golden age of justice and righteousness. “They occupied a void. There was no good government. People were tired of the clans. But they are hypocrites.” He sees the DDR programme as a potentially powerful weapon in the fight against the militants, if it is properly promoted. “We have to set up more centres like this one, and to tell the low-risk combatants to defect and be retrained and re-integrated.” In his town, among the 79 who have so far graduated from the programme, are people who are now providing jobs to their families and the community. That means that “instead of being destructive, they are now productive”, said Abdulahi. **Names changed for security reasons* oa/ag *(TOP PHOTO: Ugandan soldiers deployed with AMISOM play football with Somali children after taking back a town from al-Shabab)* as2.jpg <http://irinnews.us12.list-manage2.com/track/click?u=31c0c755a8105c17c23d89842&id=547035e4b4&e=399c7ee738> Feature <http:///feature> Aid and Policy <http:///aid-and-policy> Conflict <http:///conflict> Politics and Economics <http:///politics-and-economics> One man’s terrorist is another man’s carpenter Obi Anyadike <http:///authors/obi-anyadike> IRIN <http:///byline/irin> How DDR can shrink support for al-Shabab in Somalia MOGADISHU <http:///publication-location/mogadishu> Africa <http:///africa> East Africa <http:///africa/east-africa> Somalia <http:///africa/east-africa/somalia> *Read on <http://irinnews.us12.list-manage.com/track/click?u=31c0c755a8105c17c23d89842&id=18a8ff34bf&e=399c7ee738>* ------------------------------ More news and analysis <http://irinnews.us12.list-manage.com/track/click?u=31c0c755a8105c17c23d89842&id=b5d9d662a3&e=399c7ee738> <http://irinnews.us12.list-manage.com/track/click?u=31c0c755a8105c17c23d89842&id=146862a041&e=399c7ee738> <http://irinnews.us12.list-manage.com/track/click?u=31c0c755a8105c17c23d89842&id=4c2016945e&e=399c7ee738> <http://irinnews.us12.list-manage.com/track/click?u=31c0c755a8105c17c23d89842&id=dc43eec644&e=399c7ee738> <http://irinnews.us12.list-manage2.com/track/click?u=31c0c755a8105c17c23d89842&id=0a1c75f01e&e=399c7ee738> *Copyright © 2016 IRIN, All rights reserved.* Want to change how you receive these emails? 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