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Agonising Choices in Africa: Who will live, and who will die?

21 September 2007


Millions of people with HIV hoped that the G8 would remember its pledge to them.

Yet, the UK government has just announced a multiyear pledge that represents an annual increase of of only twenty-five million pounds.  By  spreading the contribution out over eight years, the total pledged is made to seem quite large, when in fact it is far from the tripling of the UK's annual contribution implied by the G8 agreement.

This is a transcript of Sir Elton John’s plea to the British Government to honour the pledge first printed in the Guardian on 21st  September 2007:

“When I set up the Elton John AIDS Foundation 14 years ago, my friends were dying without any hope of treatment to prolong their lives.  AIDS was a death sentence.  During the 1990s the Foundation provided palliative care, information, emotional and financial support to thousands….and prayed for a cure.
Today, antiretroviral treatment - the drugs that can literally bring someone back from the point of death - are available, affordable and entirely viable in the developing world.  I have met wonderful, courageous HIV positive Africans who are thriving because my Foundation, like many other organisations, has grasped the chance to use these medicines in groundbreaking programmes.
Yet about 70% of Africans who need treatment to survive are still not receiving it.  Ultimately, it takes the will of the richest governments on earth to close that gap. In June the G8 pledged to do just that – to provide access to HIV/AIDS treatment for all those who need it by 2010.   At the present rate, we are barely on track to meet half that target.  So, are we saying that by 2010 we will save only half of those dying from AIDS?   And, if so, how will we decide who should be spared?
Back in June, the G8 decided that one of the ways to get treatment to all those who need it would be to triple the size of the Global Fund to Fight AIDS, Tuberculosis and Malaria. This means that by 2010 it could provide US $6-8 billion to fund programmes delivering medical treatment.  Next week in Berlin, members of the G8 will attend a meeting of the Global Fund to deliver on that promise.


I believe Gordon Brown's leadership and vision on this issue is urgently needed, right now.  After all, he played a central role in bringing world leaders to commit to universal access, and he helped found the Global Fund, which has since proven itself by saving an estimated 1.8 million lives..  If the UK were to provide £700m over three years, tripling its annual contribution by 2010, it would challenge the rest of the world to follow suit.


I am not alone in this view.  The Stop AIDS Campaign, a coalition of over 80 organisations working on HIV/AIDS in the developing world, feels the same. So do leaders in Parliament, not least the Chairs of 3 All Party Parliamentary Groups responding to AIDS, TB and Malaria, who represent all sides of the political divide. A bold pledge like this from the UK would encourage other countries, such as Canada, France, Germany, Japan and the US, to do their part too.


I am not a politician.  I see this problem through the lens of my Foundation’s work,  which has no favoured ways of getting the job done.  For us, it’s about who is being effective, transparent, and keeping money flowing to benefit people living with HIV/AIDS, rather than invent more structures or processes. We expect no less from the Global Fund. But I know that in many areas the Global Fund has had impact where other, less innovative mechanisms have failed. Over 1 million people with HIV/AIDS in Africa, Asia and Latin America have already received antiretroviral medication, and 2.8 million people suffering from TB, the biggest killer of people living with HIV/AIDS, have been treated thanks to the Global Fund’s resources.
Although we are happy to acknowledge that AIDS affects everyone, it seems that not everyone is worthy of our support.  In many parts of the world governments are hostile or reluctant to provide services for the most marginalized groups: men who have sex with men, injecting drug users and people in prison generally have appallingly little access to basic HIV prevention services.  My Foundation strives to respond to this need and has been guided by what is effective in fighting HIV/AIDS rather than what is politically expedient. Through this work I have met some of the brave activists who face daily threats and harassment in order to help marginalised groups access basic information and treatment.  This is another area where the Global Fund is crucial, because it has the flexibility to channel funds directly to civil society organizations rather than toeing a particular political line.
At the United Nations this July, Prime Minister Gordon Brown showed integrity and leadership when he said “We did not make the commitment to the Millennium Development Goals only for us to be remembered as the generation that betrayed promises rather than honoured them and undermined trust that promises can ever be kept.”
These decisions directly affect whether people live or die, and I urge the British Government to take a lead in ensuring these promises are kept.  Honour the pledge.”