U4 Helpdesk Query

U4 helpdesk reply

Reply produced by: U4 Helpdesk research team, London, with expert input from Lucy Gardner (Senior Health Advisor) and Hennie van Vuuren (Senior Researcher: Anti-Corruption, ISS, South Africa)

Content

• Please provide references to reports/documents etc identifying the links between HIV/AIDS and corruption, focusing particularly on Africa.
  
• What are the specific issues concerning HIV/AIDS as distinct from links between health sector and corruption?
  
• Are there examples of initiatives to tackle corruption related to HIV/AIDS?
  
• Which are the key donors/researchers/NGOs which might be working on these issues?
  

Part 1

Please provide references to reports/documents etc identifying the links between HIV/AIDS and corruption, focusing particularly on Africa

While the effect of corruption on public health and healthcare provisions more generally has for some time been the focus of researchers, material focussing specifically on the links between HIV/Aids and corruption in Africa is scarce, and hardly goes beyond anecdotal evidence. This finding is being supported by GRC's Literature Review on HIV/Aids and Governance, which contains a comparatively small section on HIV/Aids and corruption and focuses primarily on events in China.

The scarcity of material available on this topic suggests that there would be scope for further research.

Geoff Crumplin (Inter Care, in British Medical Journal), February 1, 2003: EU reimporting drugs meant for Africa is only part of story
In this letter to the editor, Crumplin refers to an article published earlier in the same journal on measures taken by the EU to clamp down on the illegal trade in drugs reimported from African countries. Generally welcoming the proposed changes, Crumplin refers to a case in Uganda where a substantial proportion of donated HIV drugs was corruptly diverted and privately sold on the African market. This suggests that specific relabelling of drugs - as proposed by the EU - will not be sufficient to prevent the corrupt diversion of drugs, but will have to be accompanied by measures destined to ensure the delivery of the drugs to their intended recipients. See also a related article.

Richard Ingram (Agence France-Presse), Sept 26, 2003: Health-Aids-Africa: Corruption, fair access to drugs are keys to AIDS fight, Africa told
In this short article covering the last of a six-day forum on Africa's Aids crisis, Ingram refers to the closing speech by UNAIDS's Executive Director Piot who considers corruption to be a major impediment to the effectiveness of the global fight against HIV and Aids. Addressing the need for further funding, Piot warns that donor countries would only then be willing to make available more resources if they could be assured that money was going to be well spent rather than being siphoned off for purposes other than the fight against HIV/Aids, as has been the case in the past. Piot's speech can be accessed here.

Irin Plusnews, 1 September, 2003: Kenya: Corruption allegations plague AIDS body
Following allegations of corruption and misappropriation, the director of Kenya's National Aids Control Council (NACC) was suspended and further investigations were instigated by Kenya's Efficiency Monitoring Unit and the government's anti-corruption unit. It was hoped that these incidents would not affect the willingness of donors to finance Kenya's fight against HIV/Aids, as had been the case in June when the Global Fund to fight HIV/Aids, Malaria and Tuberculosis withheld a $15 million Aids grant until government addressed claims of corruption in the NACC.

Aids in Africa - Online Resources for HIV/Aids in Africa
This website contains a map detailing data on HIV prevalence, and other demographic data (perceived levels of corruption being one of them) for each country.

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Part 2

What are the specific issues concerning HIV/AIDS as distinct from links between health sector and corruption.

The linkages between corruption and HIV/Aids and associated treatments do not seem to be substantially different from the links between corruption and the health sector more generally. The major sources of corruption in the health sector in developing countries include procurement, the misappropriation of public funds earmarked for health expenditure, and informal payments by patients to health workers for services supposed to be delivered free of charge. These are facilitated by a corrupt administration, insufficient monitoring mechanisms, and inadequate enforcement of regulations governing the health sector.

What is different, however, is the scale of the HIV/Aids epidemic, its mode of transmission, the stigma attached to the disease, the absence of a cure and its projected negative impact on the development prospects of some of the poorest nations.

Aids, more than most of the other serious infections commonly leading to disability and premature death, can be prevented. Furthermore, suffering from the effects of an HIV infection or Aids can be alleviated effectively, provided that, among other factors, the system in place for administering those policies works efficiently and is free from corruption and other malpractices.

The following list suggests some links between HIV/Aids and corruption:

Issues relating to corruption in the prevention of HIV infections:

• Misappropriation of funds earmarked for public education and awareness raising: Levels of new HIV infections are believed to be significantly reduced through comprehensive awareness-raising campaigns highlighting the sources of transmission of the virus and detailing ways in which people can protect themselves and others from infection. However, the effectiveness of such approach can be seriously hampered by corruption, or the misappropriation of funds earmarked for prevention campaigns (as appears to have been the case in Kenya).
• Standards of healthcare: HIV/Aids can be prevented through for example the exclusive use of sterile needles and surgical equipment and the screening of blood and plasma donations for traces of the virus. While relatively low-cost, these measures are sometimes ignored by health workers who either do not have the means to sterilise equipment in line with medical standards (due to, for example, supplies being held up in a corrupted procurement and/or distribution process), or who have discovered the use of non-sterile equipment as an additional source of income (eg by demanding illicit payments from patients, or claiming money for the purchase of new equipment but diverting the money away from its intended use).

Issues relating to corruption in the treatment of HIV/Aids:

• Misappropriation of funds earmarked for treatment: The misappropriation of funds earmarked for the treatment of HIV/Aids can happen on both the petty and the grand scale, with actions ranging from corruption in the allocation of contracts for the building of new centres to corruption in the procurement of medicines. In Zimbabwe, the director of the National Network for People Living with Aids was found guilty, in 2002, of topping up his salary with funds misappropriated from the network, and in 2003, the director of Kenya's National Aids Control Council was dismissed following similar allegations.
• Misappropriation of medication: The comparatively expensive nature of HIV/Aids medication makes it vulnerable to the corrupt diversion of drugs. While the market for counterfeit drugs (the replacement of genuine drugs with medically ineffective substances such as sugar) or simply the theft of drugs is rife generally, the money to be made from the re-sale in the industrialised world of HIV/Aids drugs supplied at preferential prices in Developing Countries (as was the case in Uganda), or indeed inside developing countries, undermines the availability and effectiveness of treatment and impacts negatively on those unable to afford treatment at increased prices.
• Request of illicit payments for treatment: Corruption in healthcare often takes the form of health care professionals requesting informal payments and bribes for the delivery of services supposedly provided free of charge. In the case of HIV/Aids, this would include the administration of drugs, the availability of counselling and testing, and the quality and availability of treatment for both HIV/Aids and related diseases.

In summary, corruption can impede on the effectiveness of HIV/Aids prevention and treatment in a variety of ways. However, it is not necessarily among the prime causes for the spread of the disease, since countries like Botswana, where corruption is comparatively less prevalent than in the rest of Africa, are nevertheless among those most affected by HIV/Aids.

At the same time Botswana is also the African country commended by UNAIDS for its effectiveness in addressing the disease (eg through efforts to prevent the transmission of the disease from mother to child, and by making available drugs on a large scale). Even though this is not evidence enough to suggest a link between low levels of corruption and the effectiveness of a national response to HIV/Aids (which will depend on a variety of factors), the effectiveness of public service delivery more generally does depend on the extent to which corruption is perceived to exist.

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Part 3

Are there examples of initiatives to tackle corruption related to HIV/AIDS?

To our knowledge, no initiatives have been taken thus far to examine the link between HIV/Aids and Corruption.

Hennie van Vuuren, Senior Researcher (Anti-Corruption) of the Institute for Security Studies in South Africa, is currently examining the possibility of piloting a study on the link between corruption and HIV/Aids, focussing particularly on the process of distribution of medication.

He has established contacts with Zacki Achmat, head of the South African NGO Treatment Action Campaign, who is reportedly keen to pick up on the issue.

Hennie can be contacted at hvanvuuren@issct.co.za

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Part 4

Which are the key donors/researchers/NGOs which might be working on these issues?

An obvious point of call would be UNAIDS, whose Executive Director, Peter Piot, has repeatedly drawn attention to the fact that money earmarked for HIV/Aids treatment and prevention purposes does not always reach the intended recipients.

The World Bank should, in line with its corruption prevention policy, strive to ensure the proper use of the resources disbursed through its network in African countries. A 1999 article by Agence France Presse indicates that there is awareness, among the Bank's Africa department, of a majority of funds intended for the purchase of drugs not being used in this way.

Further information could be obtained from the Global Fund to fight Aids, Tuberculosis and Malaria in light of its actions following allegations of corruption in Kenya's Aids control body.

Finally, the US as one of the major donors of funds for the treatment of HIV/Aids also has a track record in addressing corruption abroad, and may be engaging in a programme to monitor the disbursement of resources. Unfortunately, we were not able to confirm specific information on the latter (in terms of existing active initiatives, etc.) at this stage.