AIDS and Health Systems Strengthening

- AIDS advocates are health systems advocates and human rights advocates.  PLWHA need strong health systems: our lives depend on them. AIDS advocates continue to defend the fundamental right to health for all especially those most marginalized in all our societies – women, children, sex workers, gay men, prisoners, injecting drug users and refugees.

- 30 years on from the Alma Ata declaration, universal access to health care remains a dream – not for the lack of resources but absence of political will. AIDS advocates will continue to mobilize and demand greater accountability from our governments and the international community to deliver equal access to health care for all.

- Some voices in the health care debate are claiming that the response to HIV/AIDS is weakening primary care in many countries, diverting funding and health care personnel and distorting health systems.  Some donors are considering supporting "horizontal" general health programs at the expense of "vertical" disease specific-programs, including HIV/AIDS.

- We must not be fooled by false debates that lead to false choices.  We can and must both strengthen health systems and scale up HIV/AIDS treatment and prevention services.  Today only one in three people who urgently need antiretroviral therapy have access to it. 

• HIV has not "diverted" resources but instead greatly expanded total health financing.   It has "distorted" health systems to the degree that it has increased the accessibility and quality of services for one devastating disease.

- In most countries with serious HIV epidemics, health systems were not healthy before the epidemic.  The AIDS response has opened up a sense of possibility for change, for progress in providing health care to all who need it.

- We believe that AIDS requires an exceptional response not just to stop the needless human toll - in 2007, 2.5 million people became newly infected and 2.1 million died of AIDS - but also to finally begin to address the structural issues of patriarchy, gender inequality, poverty and marginalization.  Unless we confront these issues we cannot ensure universal access to health for all.

New ITPC report on AIDS and health systems

- The new ITPC Missing the Target report includes original, on the ground research in Argentina, Brazil, Dominican Republic, Uganda, Zambia and Zimbabwe.  (The report is at www.aidstreatmentaccess.org and www.itpcglobal.org) The research found that:

• the HIV/AIDS response has had far-reaching positive impacts on health care in many settings: building infrastructure and systems, raising the bar on quality, extending the reach of health care to socially marginalized groups, and engaging consumers.
• AIDS service scale up has also revealed existing fragilities in health systems, and in some cases have placed increasing burdens on these systems and the health workers so crucial to delivering health for all
• The AIDS response has been largely successful because of significant new resources AND the engagement of advocates and health consumers who forced global and national leaders toward a more vigorous sense of accountability and urgency.

- We need to do for health systems what we've done for AIDS.  With increased resources, accountability for outcomes, and consumer engagement, the move towards prioritizing and supporting broader health system strengthening could have enormous benefits for communities as a whole, including people living with HIV

- Without these elements, there is the serious risk of creating a bureaucratized approach to health that fails communities and leaves millions living with HIV without desperately needed care.