France & the fight against HIV and AIDS in South Africa
France & the fight against HIV and AIDS in South Africa
Since the beginning of the epidemic, France has been very much involved in the fight against HIV/AIDS, in research as well as in the implementation of control program. As part of its support to the Millennium Development Goals, France has been constantly increasing its efforts to promote access to health in developing and emerging nations, with a specific focus on the fight against HIV/AIDS. France has been one of the first countries promoting universal access to antiretroviral treatment. Its commitments have had direct impacts on the lives of thousand of people worldwide, including in South Africa.
France is fully committed to implement in South Africa the recommendations of the Paris and Accra declarations on aid effectiveness. Thus, not to overlap with other donors, France does not intend to develop major bilateral health programs.
In South Africa, France’s financial support to the fight against HIV/AIDS is mainly channelled through multilateral initiatives such as the Global Fund against HIV/AIDS, Malaria and Tuberculosis. South Africa also indirectly benefits from the French diplomatic efforts to develop innovative financing systems against HIV/AIDS such as UNITAID.
The Global Fund to Fight AIDS, Tuberculosis and Malaria was set up in 2002, with an active support of France. It has since become one of the main international sources of funding for health programmes, with over $ 22 billion disbursed to finance health programs in 144 countries . The Global Fund has been widely praised for its achievements and has been described as the “most successful innovation in foreign assistance over the past decade”.
From 2011 to 2013, France’s commitment to the Fund reached €360 million per annum. On July 15th of 2013, the French President, after a meeting with Professor Françoise BARRE-SINOUSSI, Nobel Prize of Medicine and co-discover of the AIDS virus, officially announced that France will contribute to the Global Fund for at least the same amount from 2014 to 2016, or a minimum of €1.08 million. This commitment has been officially confirmed at the Fourth Voluntary Replenishment Conference that took place in Washington DC in December 2013. As such, France will remain the second largest contributor behind the United States.
At the end of 2012, programs supported by the Global Fund provided antiretroviral therapy (ART) to 6.1 million people (against only 2.5 in 2009). Thanks to these programs, 11.1 million people also benefited from TB treatment and 360 million mosquito nets to prevent malaria were distributed.
In South Africa, since 2002, the Global Fund has committed $348.8 million to support 6 programs against HIV/ AIDS and TB. From this amount, more than $47 million are coming from France. These programs have been carried out by national and provincial government departments and by civil society organisations. They aim at expending services and strengthening capacities in prevention and treatment of HIV and TB. Presently, 2.2 million persons are under ART in South Africa, and approximately half of them benefits from the Global Fund’s support. A new request from South Africa has recently been received by the Global Fund for $260 million for HIV and $55 million for TB.
Among the major obstacles to the fight against poverty and diseases are the unpredictable variations of aid flows. France has therefore been striving to design and promote innovative financing mechanisms which create steady and growing flows of resources. It has, for instance, been instrumental in the setting up of UNITAID}.
Focused on the fight against HIV/AIDS, TB and Malaria, UNITAID, the International Drug Purchase Facility, aims at reducing the cost of quality medicines and diagnostics. UNITAID’s financing model is based on the purchase of high volumes of medicines and diagnostics in order to reduce prices. More medicines and treatments can then be provided with the same budget. UNITAID also supports the Medicines Patent Pool Foundation, which objective is to facilitate the exchange of patents on drugs and medical equipment.
To implement this strategy, UNITAID has raised more than $804 million since its inception in 2006. Of this amount, $489 million came from France.
UNITAID funding comes from two reliable and stable resources: the multi-annual commitments of donors as well as a solidarity levy on airline tickets. This levy, implemented in 11 countries, contributes to more than 70% of UNITAID’s finances. Through this mechanism, France was able to raise more than €140 millions in 2009 and remained the first contributor to UNITAID.
Although UNITAID does not directly work in South Africa, it is a significant funder of the Global Fund and contributes to an overall decrease of medicine and equipment (GeneExpert, Point of Care) prices which benefit to South Africa.
France remains a leading force to advance the innovative financing agenda. It is for instance in charge of the secretariat of the Leading Group on Innovative Financing for Development, the main international forum seeking to scale up innovative financing. France’s commitment is also illustrated by its pledge to provide € 1.2 billion over 20 years to the International Finance Facility for Immunisation (IFFIm).
In February 2008, President Nicolas Sarkozy committed to provide a direct support to priority health projects in South Africa. The French Development Agency (AFD) has subsequently funded two different programmes, implemented by the Desmond Tutu HIV Foundation and the Western Cape Province:
AFD granted € 300,000 to the Desmond Tutu HIV Foundation to increase its capacity to diagnostic and treat HIV/AIDS and TB in the Western Cape. This support will enable the Foundation to purchase a mobile testing unit and to build two additional consulting rooms.
The Western Cape Province benefited from a €1.2 million grant provided by AFD to extend and renovate the Grabouw Community Health Centre and the Inzame Zabantu clinic in Mitchell’s Plain. This centre has been officially inaugurated on June 20th of 2013 by M. Theuns Botha, Minister of Health of the Western Cape province, and by H.E. Elisabeth Barbier, Ambassador of France in South Africa.
A number of Franco-South-African research partnerships on HIV/AIDS have also been set up, involving French organizations such as IRD, ANRS, CNRS, INSERM and the Pasteur Institute. ANRS (the French National Research Agency on Aids) has for instance supported a significant pilot a project on male circumcision and HIV prevention in the Orange Farm Township, Gauteng.
Lastly, a number of French Non Governmental Organizations are also involved in the fight against HIV/AIDS in South Africa, including Le Secours Populaire Francais, Sidaction, Ensemble luttons contre le sida en Afrique (ELSA) and le Comité catholique contre la faim et pour le développement (CCFD).
France has always actively participated in research against HIV: fundamental research, clinical and programmatic research. The HIV virus was discovered by a team of researchers of the Institut Pasteur, leaded by Professor Montanier and Barre-Sinoussi in 1983.
The French Research Agency against AIDS and Hepatite (ANRS) is financing research on HIV/AIDS in France and all around the world. Two important projects have been carried out in South Africa with ANRS financial support:
- The "Bophelo Pele Project", implemented in the township of Orange Farm (Gauteng province) from 2007 to 2011, has confirmed the effectiveness of medical male circumcision in prevention of HIV infection. As a consequence of this study, male circumcision is currently recommended by WHO and UNAIDS as a preventive measure against HIV infection and implemented alla around the world, included in South Africa.
- The "Treatment as Prevention (TasP) pilot project in Hlabisa, Kwazulu-Natal, currently under implementation by the Africa Centre and the Institut de santé publique, d’épidémiologie et de développement of Bordeaux. This study started in 2011 with a €3 million grant from ANRS aims to demonstrate that antiretroviral therapy initiated immediately after diagnosis of HIV-infection may decrease HIV incidence in the surrounding population. The first phase has been completed in December 2013. The second phase will continue from 2014 until 2016, with a new ANRS funding of €3 million.