If only I had noticed this article yesterday, I could have saved myself writing another blogpost. But so it goes.
The article, from Uganda’s New Vision newspaper, reports that Dr Zainab Akol, the AIDS control manager, has accused sexual minority rights groups of “derailing” the fight against HIV. Her specific complaint is that the Global Fund to Fight AIDS, Tuberculosis and Malaria has turned down Uganda’s application for US $270 on the grounds that the country’s policies on sexual minority rights are too harsh. Keep in mind that Uganda is the country that is considering passing legislation to further criminalise homosexuality: at one stage sponsors of the bill wanted to include the death penalty as a punishment for “aggravated homosexuality”. Keep in mind also Uganda’s dismissive response to David Cameron’s suggestion that the UK would withhold aid to countries that do not guarantee the rights of sexual minorities.
Here is what Dr Akol is quoted as saying:
“By the time we are through with one group’s rights, we have 130,000 new infections,” she said, adding: “It is as if the global agenda is to use HIV to propagate sexual minority groups. Let them use the proper channels to deal with such issues.” Currently, Uganda has 700,000 people who need ARVs, but only 300,000 are on the lifesaving drugs. “We had asked for $270m for round 10 of the Global Fund. We could have used part of it to put 100,000 people on ARVs,” Dr. Akol said in an interview.“We need effective care and support as a preventive strategy, not the minority issues that are being forced into the fight against HIV/AIDS”
The article was published on Novermber 15th 2011. But the decision that Dr Akol is talking about is not a recent one. She is referring to Uganda’s Round 10 application, submitted during 2010 and over which the Global Fund took a decision the same year, during its December 2010 Board Meeting. As has always been the case, the Board accepted the recommendations of the Fund’s Technical Review Panel (TRP) when deciding which grant applications to approve. Uganda’s Round 10 application for HIV was an interesting case since part of the US$270m application was for “Health systems strengthening” (HSS) and the rest was for HIV programmes. The TRP took the decision of recommending the HSS component (worth about US$25m) for funding but not the remainder. They cited four major weaknesses and two minor weaknesses in the HIV-specific component, and stated that if these weaknesses were to be resolved the proposal could be resubmitted in the next round and considered for funding once again. Any one of the major weaknesses would have been sufficient grounds to turn the proposal down.
The list of weaknesses would suggest that “gay rights” were not the only reason the proposal was turned down. In fact, the first reason mentioned was that only 11.6% of Uganda’s previous grant had been disbursed, suggesting that the current portfolio contains a considerable underspend that could be allocated to activities in the Round 10 proposal. Next, the budget for the Round 10 proposal was described by the TRP is “questionable”, and if there is one thing that the Global Fund doesn’t like it is a questionable budget. The third major weakness was to do with human rights:
The section on enhancing social and gender equity… do[es] not adequately address human rights of most-at-risk populations. Moreover the proposal does not contain a statement on equitable access to… treatment for all Uganda citizens, including the most-at-risk groups in the society. Such statements and references are of utmost importance at a time when the human rights of most-at-risk populations in Ugandan [sic] are at stake.
So, there is a recognition of the current febrile situation in Uganda but the concerns seem to be mainly around ensuring access to services. A fourth major concern from the TRP states that the design of the proposal is not sound since it is based on weak situation assessments and poorly targeted.
Given this background, the New Vision article’s interpretation starts to look pretty weak. By all accounts Uganda probably does have some of the money it needs to expand its treatment programme. And the part of the proposal that was turned down had all sorts of weaknesses.
More worrying, it looks like another example of the whole debate about human rights conditionality being used to further stigmatise marginalised groups. As if LGBT rights activists in Uganda weren’t getting enough of a hard time already, now they are being accused of compromising access to healthcare for hundreds of thousands of Ugandans.
It is hard to know what the Global Fund should do about human rights. As I argued a few months ago, I’m skeptical about suggestions that the Fund should put in place even more controls to ensure programmes are respectful of human rights because I’m just not sure a Geneva-based organisation is going to be able to adequately measure the issues, and because I’m certain the Fund’s secretariat doesn’t need even more power. On the other hand, the TRP’s attitude to Uganda’s Round 10 application is interesting since it showed that it is possible to fund some parts of an application and not others. Maybe that’s the way things need to go: try to fund as much as possible of what is acceptable. And at the same time, try to find alternative ways of supporting human rights and justice movements rather than doing anything that might further undermine them. If the Global Fund is to effectively tackle things like sexual minority rights, maybe it is time it started making more money more easily available for organisations representing marginalised groups, so that they can act as effective counterweights to the mainstream.
— Update (17.18 GMT, 16th November) —
The Global Fund press office has emailed me the following brief statement in response to the New Vision article:
A report in the Ugandan media contains inaccuracies as to the reasons why the Global Fund rejected a recent application for HIV funding.
In 2010, Uganda submitted a Round 10 application to the Global Fund asking for $217 million for HIV and $25 million for health systems strengthening.
The application was examined, along with all grant proposals, by an independent panel of international experts on health and development to evaluate soundness, effectiveness and viability. Based on the panel’s recommendations, the Global Fund Board approved the $25 million proposal for health systems strengthening but rejected the HIV proposal.
The panel of experts turned down the proposal mainly because significant funds from an earlier HIV grant are still unspent, raising doubts about Uganda’s ability to take on a much larger HIV grant before it had effectively invested the resources it already has available. The HIV proposal also failed to adequately address equitable access of services particularly with respect to particularly vulnerable populations. Following an appeal by Uganda, the Global Fund’s Independent Appeals Panel upheld the decision not to fund the HIV proposal.