September 25, 2003

1. The role of the World of Work in HIV/AIDS remedial efforts is now well recognized thanks to the efforts of the International Labor Organization (ILO). The ILO HIV/AIDS program in three years is now a major strategic, policy and programmatic force in global efforts to stem the tide of HIV epidemic. Dr. Franklyn Lisk the Director of the program and Assane Diop the Executive Director for Social Protection, ILO, deserve special commendation for their work in the last three years.

2. The ILO program on HIV/AIDS and the World of Work is based on a tripartite arrangement of employees, employers, and governments. The tripartite framework of the ILO and its HIV/AIDS program provides a useful vehicle for mobilizing resources in poor countries. In many resource-poor regions such as Africa, the government is a major source of livelihood for most citizens. The private sector is also important, especially in countries that are the location of conglomerates such as South Africa and Nigeria. The gold mines of South Africa and oil fields of Nigeria are important testing grounds for ILO's tripartite framework in AIDS remedial efforts.

3. It is important to closely observe the ongoing efforts to roll out a nationwide antiretroviral program in South Africa. I believe that the tripartite framework will be severely tested in South Africa for three main reasons: (A) The high prevalence and incidence rates of HIV in South Africa; (B) The significant influence of conglomerates in the national economy of South Africa, and; (C) The role of sophisticated trade unions that brought Apartheid to its knees. In recent years, a fourth element, the academia, especially policy-oriented institutions, have joined in organized efforts to improve HIV preventive programs and provide access to life enhancing therapy in South Africa.

4. For the Western countries, in this case, United States, the situation is radically different from that of resource-poor countries. The push for strong government response to HIV/AIDS came mostly from individuals and families living with HIV/AIDS. Then, the struggle moved to urban America where minority-based organizations and individuals living with the disease pushed both local and state governments to take action. At the national level, the Congressional Black Caucus played a key role in getting the Clinton Administration to take a stronger stance on domestic AIDS remedial efforts.

5. Regarding advocacy efforts in the United States for Africa, the epicenter of the epidemic, African-focused or oriented organizations such as the Constituency for Africa and AFRICARE led the initial response. The Constituency for Africa (CFA) organized scores of high profile Town Hall meetings that brought together key stakeholders across urban and rural centers of the country. CFA, like most of the Africa-focused organizations, although located in urban areas, had extensive grassroots contacts with small town and rural based advocacy organizations and faith-based entities.

6. To champion AIDS remedial efforts in Africa, US based organizations focused on four strategies: (A) Fact-based policy reviews of intervention options and strategies; (B) Developing and sustaining relationships with members of the US Congressional Black Caucus; (C) Establishing mutually agreeable partnerships with organizations that are active in domestic HIV/AIDS remedial efforts and community-based development programs, and; (D) Forging relationships with the academia, think tanks and research institutions on the science and strategies of remedial efforts.

7. In the United States, the role of the UN system in HIV/AIDS advocacy efforts is still evolving. The high profile given to HIV/AIDS by the Secretary General Kofi Annan has raised the visibility of the UN and its potential role in mobilizing public and private sector resources in America.

8. As we move into what I call the "financing" phase of HIV/AIDS worldwide, it is important to emphasize the tripartite framework championed by the ILO. This approach should combine the science of AIDS remedial efforts with the tough moral choices that policy makers in rich nations must face in the fight against this disease. Why should a man with four small children die in South Africa of AIDS when his counterpart in United States can manage his condition with lifesaving drugs?

9. As the private sector becomes increasingly visible and effective in the fight against HIV/AIDS, it is important to get business leaders to buy into the tripartite framework. This framework should be partnership-based rather than adversarial. It is also important to emphasize "what works" to business leaders. The impact of intervention programs should continue to receive appropriate attention. It is also important to emphasize process and impact indicators since they are crucial to winning new converts in decision-making positions in both the public and the private sector.

10. A major lesson I have learnt as a Board Member of the Constituency for Africa is that policy makers are willing to pay attention and act swiftly if advocacy is fact-based and respectful of contrary opinions and strategies. In the World of Work and HIV/AIDS, we should focus on fact-based advocacy, partnership building, stakeholder comparative advantages, and maximization of scarce resources. The ILO and other UN agencies have a unique role as neutral arbiters to provide leadership in this process.

Finally, the role of resource poor countries in HIV/AIDS remedial efforts in their own countries is crucial. It is important for each country to be seen as seriously addressing the epidemic, even with meager resources. Each country should mobilize its stakeholders, ensure fairness and equity in the distribution of national resources, and make transparency in national affairs, a priority. No country should allow a situation where concerns about its public accountability system or governance should be a militating factor in internationally directed HIV/AIDS remedial efforts.

Thank You.

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Dr. Chinua Akukwe (cakukwe@att.net; cakukwe@gwu.edu) is a member of the Board of Directors of the Constituency for Africa, Washington, DC and a former Vice Chairman of the National Council for International Health (NCIH) now known as the Global Health Council, DC. Dr. Akukwe is an adjunct professor of public health at the George Washington University, DC and has published extensively on HIV/AIDS in Africa and development issues.

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