French policy on international cooperation in the fight against HIV/AIDS in developing countries

A long-standing French commitment...

One fundamental characteristic of French action in the fight against HIV/AIDS is its resolute commitment to its own sufferers from the very beginning of the epidemic, a commitment it was strongly urged and driven to make by lobbying from community-based associations. This has radically changed the way that society and the medical community see and act in relation to the disease and its victims. Daniel Defert, who initiated the AIDES association, wrote, as early as 1984, in a seminal text: “...I knew that AIDS was an issue that could not for long be confined to the status of a medical problem...” and, arguing that the “sharing of medical knowledge... ownership of medical knowledge...” by those suffering from the condition, puts the individual, the community, at the very heart of the structure as a participant impossible to ignore: “the community will soon be the best informed group on problems relating to the immune system...”. [26] It is against this background that the French government’s programme in support of the combat against HIV/AIDS in the developing nations also started up very early, in 1985. The first epidemiological surveys, conducted on samples of the general population in Central Africa, enabled a initial measure of the scale and gravity of the problem, an assessment of its geographical distribution and its main aspects, and the implementation of the first tools for effective surveillance of what was at that time no more than an epidemic. An emergency programme was launched to provide screening kits to blood banks and transfusion units in partner countries and to develop special information, education and communication (IEC) actions as part of national programmes against the disease put gradually into place with WHO encouragement.

The spread of the pandemic outside the main urban centres and the growing awareness on the part of the governments of partner countries in Africa of the increasingly drastic health-related, economic, social and cultural impact that AIDS was having on their national development, led them to ask for even more active French involvement in assisting them. Thus, as early as July 1993 in Abidjan, Ivory Coast, the French government affirmed its determination to intensify its effort in the fight against AIDS and to make this one of its priority programmes.

This engagement, confirmed in December 1994 in Paris at the Summit devoted to the combat against AIDS, resulted in a significant increase in the budget and human resources mobilised, which were concentrated on a small number of particularly severely affected countries, most of them in Frenchspeaking black Africa. The Paris Summit also made clear, as it did for all the signatory countries, the overall strategic context of the intervention of the French government in relation to a number of essential points: “To protect and to promote, by means of a legal and social environment, the rights of individuals, and notably individuals living with HIV/AIDS and those most exposed to risk of infection; to involve fully in the action taken the government authorities, nongovernmental organisations, community- based associations and those living with HIV/AIDS; to act to ensure that the law guarantees individuals living with HIV/AIDS equal protection in terms of access to health care, employment, education, freedom of movement, housing and social welfare”  [27].

...which has brought major resources to bear

On the basis of the conclusions reached in the external evaluation of the programmes to fight HIV/AIDS over the decade from 1987 to 1997  [28], the efforts made by the French government to help developing countries represented, on a full year basis, excluding multilateral commitments  [29], an average of euros 12,2 million in total actual expenditure, including technical assistance, which accounted for virtually a quarter of all resources devoted to the health domain. This financial effort was split between projects as such, 62% of the total, and technical assistance (35%), with the remainder being devoted to non-project study grants, intervention funding from decentralised government bodies to diplomatic posts, and co-funding by the French Ministry of Foreign Affairs of projects supported by French Organisations for International Solidarity and NGOs.

In the two-year period 2000/2001, 45 projects supporting the combat against HIV/AIDS based on a specific approach or making the intervention part of an integrated public health project and/or field research project, are currently being conducted or actively studied in 28 countries in the so-called Priority Zone of Solidarity (including 8 non- French-speaking countries) and all Caribbean countries, the total amount involved being over euros 30,5 million, as evaluated over the duration of the projects or programmes  [30].

At the same time, 300 technical assistants in the health organisation deployed externally, almost twothirds are involved for part or all of their time in the combat against HIV/AIDS (30 devote all their activity to this and 15 at least threequarters of their working time).

COUNTRIES (Bilateral Projects))	Special HIV/AIDS projects	Integrated public health programmes		TOTAL
		Total	including HIV/AIDS
Angola	1.22			1,22
Benin	1.83			1,83
Burkina Faso	1.37	1	0.46	1,83
Burundi	0.76			0,76
Cambodia	0.46	1.22	0.36	0,82
Cameroon		1	0.79	0,79
Central Africa	0.93	0.76	0.46	1,39
Congo		1.52	0.59	0,59
Ivory Coast	3.05	2.74	0.23	3,28
Djibouti	1.72			1,72
Gabon	0.91	0.91	0.08	0,99
Guinea Bissao	0.46			0,46
Madagascar		3.51	0.76	0,76
Mali	1.37			1,37
Mauritania		2.44	0.17	0,17
Mozambique	1.22			1,22
Namibia	0.91			0,91
Niger	0.76			0,76
Rwanda		0.91	0.15	0,15
Senegal	1.83			1,83
Togo		2.29	0.46	0,46
Zimbabwe	0.91			0,91

Public interest projects
Research	4.88			4,88
CAREC	3,81 + 3,2			7,01

Mobilising programmes
East Africa	1.52			1.52
CAREC	1.07			1.07
North/South association networking	2.29			2.29

Decentralised overseas cooperation

0.38

0.38

UNAIDS

3.13

3.13