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Open Letter to African Finance Ministers at the IMF and WORLD BANK Spring Meetings from Members of the Pan-African Treatment Access Movement The Pan African Treatment Access Movement (PATAM)
Pan African Treatment Access Movement (PATAM)
April 22, 2004

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Open Letter to African Finance Ministers at the IMF and WORLD BANK Spring Meetings from Members of the Pan-African Treatment Access Movement The Pan African Treatment Access Movement (PATAM)
April 22, 2004

Dear African Finance Ministers,

On 24 and 25 April, you will convene in Washington DC for the annual International Monetary Fund (IMF) and World Bank Spring Meetings to review the two institutions’ operations. As government representatives we understand that your mandate is to ensure that the interests of all residents in your countries are fully met. As you are well aware, the greatest threat facing the African continent today is the HIV/AIDS epidemic.

We, the members of an Africa-wide movement advocating for access to HIV/AIDS treatments and other essential medicines, encourage you to consider the HIV/AIDS as an issue affecting all other critical developmental issues and urge you to consider initiatives that will help contain and reverse the steady march of the epidemic.

In particular, we ask that you enhance the current efforts by the World Bank and IMF against HIV/AIDS but reject those initiatives that hamper access to life-saving and affordable medicines for people living with HIV/AIDS.

In the last few years, as the costs of antiretroviral therapy have steadily declined and some misconceptions most notably on the efficacy and safety of the drugs have been proven unfounded. Treatment has become recognised as a critical component in the response against HIV/AIDS. At a conference of African activists held on March 3-5 in Harare, we heard reports from representatives from countries across Southern Africa that treatment rollout is either on the verge of starting, or has already begun in most countries across the region.

We welcomed these reports since they send many a ‘ray of hope’ to those infected and affected by HIV. However, we were also told that despite the increased willingness by all stakeholders, whether private or public, to provide Antiretroviral Therapy (ART), many initiatives do not have the financial resources to respond adequately. We write to encourage you to consider state sponsored initiatives to fund programmes to scale up Access to Treatment in your respective countries.

Currently, we recognised that many government-led initiatives in Africa can only meet a fraction of the treatment needs and therefore have to rely on external support from donors and international initiatives such as the Global Fund for HIV/AIDS, TB and Malaria (GFTAM). This is an unsustainable situation with potentially very serious public health consequences should the donors withdraw support. This is not a new issue: African Heads of States meeting in Abuja, Nigeria in April 2001 declaredthat "we recognise the need to establish a sustainable source of income to fund HIV/AIDS program."

We therefore ask that urgent attention is paid towards building the internal capacity of our countries to marshal their own resources against HIV/AIDS. We see the Spring Meetings is such an opportunity to raise the following issues with the IMF and World Bank.

The Policy Space Occupied

While we have witnessed some movement away from the view that markets function perfectly and governments should interfere as little as possible, this orthodoxy still influences policy decisions and priorities taken by the IMF and World Bank. There are numerous examples that you are very familiar with in which as a condition for receiving loans or other grants from these institutions, you have been compelled to give up state responsibility in the provision of some social services. We highlight only one.

One of these conditions that we have referred to is that you must ensure our governments maintain fiscal discipline – in other words they do not spend more than is budgeted for in a given financial cycle. This is on the surface reasonable, however in practice there are situations where it is necessary to borrow from the future to meet the urgent needs of today and therefore spend beyond current revenue sources. The HIV/AIDS epidemic is precisely such a case since if we are not willing to borrow from the future, there simply will be no future. This requirement becomes even more impractical and ludicrous when you consider cases where you have had to contemplate declining additional donated revenues for HIV/AIDS since it may mean breaching that spending ceiling you have set. We ask you to reject these kinds of conditions.

Debt Cancellation

It has been widely recognised that many countries on our continent shoulder an enormous debt burden much of it granted by the IMF and World Bank. Given the scale, much of this debt will never be fully repaid and furthermore much of it is "odious" having been accumulated by leaders who were largely unaccountable to us. While efforts such as The Heavily Indebted Poor Countries (HIPC) initiative recognise these simple truths and wish to offer relief, it is not enough to cancel some of these debts especially when you still find yourselves weighing whether or how much to spend in debt servicing over social services. You should demand full debt cancellation.

Democratising the IMF and World Bank

Finally as you yourselves recently noted at a meeting in Johannesburg, the largest recipients of aid from these two bodies – you and other so-called developing nations contributed very little to the decision-making processes. This must change. We therefore fully support yours and all other efforts to shed the light of transparency, accountability and representation into these two institutions.

We firmly believe that if these issues are sufficiently raised and implemented, they will go a long way in freeing up our countries to respond much more effectively and sustainably against HIV/AIDS. In the long run, we must stop knocking at the doors of these institutions since though we may win some gains, we are essentially beggars subject to the goodwill of one who has more. Let us develop our own capacity.

We charge you with this responsibility and remain ready to offer any support necessarily but also reserve the right to use all tools available to us should we feel that you do not represent the interests of all peoples in our countries. Millions of lives are at stake!


Members of the Pan-African Treatment Access Movement.

For more details contact PATAM

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