THE LETHAL COMBINATION OF HUNGER AND HIV/AIDS IN

UNCLAS SECTION 01 OF 04 ROME 000876 SIPDIS AIDAC FROM U.S. MISSION IN ROME AMEMBASSY ADDIS ABABA FOR AMBASSADOR BRAZEAL AND USAID DEPUTY DIRECTOR FREEMAN UNCLASSIFIED PAGE 02 ROME 00876 01 OF 04 040821Z USAID/W FOR ADMINISTRATOR NATSIOS, D/A SCHIECK, AA/DCHA WINTER, AA/AFR NEWMAN AND DAA/AFR BROWN, DCHA/D/FFP LANDIS, D/OFDA MCCONNELL, AA/GLOBAL PETERSON STATE FOR P U/S GROSSMAN, U/S LARSON, IO A/S HOLMES, A/S PRM DEWEY, A/S AFR KANSTEINER, AFR/EA, IO/EDA WINNICK USDA/FAS FOR U/S PENN AND CHAMBLISS USDA/FAS NAIROBI FOR KESSLER USMISSION GENEVA FOR AMBASSADOR MOLRY AND USAID/KYLOH BRUSSELS FOR AFRICA WATCHERS AND USAID/LERNER NSC FOR JDWORKEN AND AFRICA DIRECTORATE E.O. 12958: N/A TAGS: EAID AORC PREF EAGR AORC PREF EAGR AORC PREF EAGR AORC PREF EAGR EU WFP UN EU EAID WFP UN EU EAID WFP UN EU EAID WFP UN SUBJECT: THE LETHAL COMBINATION OF HUNGER AND HIV/AIDS IN ETHIOPIA AND SUB-SAHARAN AFRICA REF: (A) ROME 00760, (B) 02 ROME 05133, (C) 02 ROME 05058 -------------- SUMMARY -------------- ¶1. WHILE VISITING FEBRUARY 15-21 IN ETHIOPIA (REPORTED REF A),IT BECAME CLEAR THAT FURTHER AND IMMEDIATE ATTENTION IS NEEDED BY THE UNITED NATIONS AND ITS PARTNERS IN ADDRESSING THE INSIDIOUS POTENTIAL OF HIV/AIDS TO TURN DROUGHT CRISES INTO CATASTROPHE. END SUMMARY. -------------- BACKGROUND -------------- UNCLASSIFIED PAGE 03 ROME 00876 01 OF 04 040821Z ¶2. THE RAVAGES OF HIV/AIDS IN ETHIOPIA REQUIRE SPECIAL ATTENTION. WHILE VISITING FEBRUARY 15-21 IN ETHIOPIA, WE WERE GIVEN A SET OF NUMBERS - AN ESTIMATED 2.2 MILLION ADULTS AND CHILDREN INFECTED (UNAIDS AND MOH),WITH A NATIONAL PREVALENCE OF 6.6 PERCENT PER GOVERNMENT (GFDRE) SENTINEL SITES; AND AN ESTIMATE OF 10 - 23 PERCENT PREVALENCE (2002) IN URBAN AREAS. ¶3. AS FRIGHTENING AS THESE NUMBERS ARE, AS PER A REPORT ISSUED BY THE NATIONAL INTELLIGENCE COUNCIL (AVAILABLE ON THEIR WEBSITE),ENTITLED "THE NEXT WAVE OF HIV/AIDS: NIGERIA, ETHIOPIA, RUSSIA, INDIA AND CHINA" (SEPTEMBER 2002),THEY MAY BE UNDERESTIMATES. QUOTE: "GOVERNMENT FIGURES CITE 2.7 MILLION ETHIOPIANS CURRENTLY AS HIV POSITIVE, ALTHOUGH EXPERTS BELIEVE THE ACTUAL NUMBER MAY BE BETWEEN 3 AND 5 MILLION. THE GENERALLY POOR HEALTH OF ETHIOPIANS AS A RESULT OF DROUGHT, MALNUTRITION, LIMITED HEALTHCARE, AND OTHER INFECTIOUS DISEASES HAS CAUSED HIV TO PROGRESS RAPIDLY TO AIDS. LOOKING AHEAD, WE EXPECT 7 TO 10 MILLION WILL BE INFECTED BY 2010 BECAUSE OF THE HIGH CURRENT RATE OF ADULT PREVALENCE, WIDESPREAD POVERTY, LOW EDUCATION LEVELS, AND THE GOVERNMENT'S LIMITED CAPACITY TO RESPOND MORE ACTIVELY." END QUOTE. ¶4. THE REPORT DRAWS A NUMBER OF CHILLING CONCLUSIONS: -THE PROFESSIONAL CLASSES IN ETHIOPIA ARE PARTICULARLY VULNERABLE BECAUSE ADULT PREVALENCE RATES ARE HIGH AND RELATIVELY FEWER ELITES ARE CONCENTRATED IN A SMALL NUMBER UNCLASSIFIED PAGE 04 ROME 00876 01 OF 04 040821Z OF KEY POSITIONS; -THE DRAG OF AIDS ON ECONOMIC GROWTH WILL FURTHER REDUCE THE ABILITY OF THE GOVERNMENT TO HANDLE THE RISING SOCIAL AND HEALTHCARE COSTS; -THE FURTHER DETERIORATION OF GOVERNMENT INSTITUTIONS COULD WEAKEN ETHIOPIA'S ABILITY TO CONTINUE TO PLAY A REGIONAL LEADERSHIP ROLE; -RISING SOCIAL TENSIONS OVER AIDS COULD EXACERBATE REGIONAL AND ETHNIC TENSIONS WITHIN ETHIOPIA. -------------- -------------- HUNGER AND HIV/AIDS - "THE MOST FEROCIOUS ASSAULT ON WOMEN EVER" (STEPHEN LEWIS, UNAIDS) - LESSONS FROM SOUTHERN AFRICA -------------- -------------- ¶5. WFP PASSED ALONG TO US MISSION THIS WEEK COPY OF A WFP EXECUTIVE DIRECTOR JIM MORRIS/UNAIDS SPECIAL ENVOY STEPHEN LEWIS REPORT RELATED TO THEIR VISIT TO SIX SOUTHERN AFRICAN DROUGHT-AFFECTED COUNTRIES JANUARY 22-29, 2003. THEY SUMMARIZE THEIR PRINCIPAL FINDING AS FOLLOWS: (QUOTE) UNCLASSIFIED UNCLASSIFIED PTQ7274 PAGE 01 ROME 00876 02 OF 04 040821Z ACTION SSO-00 INFO LOG-00 AF-00 AID-00 ANHR-00 E-00 UTED-00 TEDE-00 IO-00 NEA-00 NSCE-00 OIC-02 PM-00 P-00 SS-00 TEST-00 SA-00 PMB-00 PRM-00 SAS-00 /002W -------------- 3E8CDE 040821Z /38 P 040726Z MAR 03 FM AMEMBASSY ROME TO AMEMBASSY ADDIS ABABA PRIORITY SECSTATE WASHDC PRIORITY 8540 USDA FAS WASHDC PRIORITY 2576 INFO AMEMBASSY ASMARA AMEMBASSY NAIROBI EU MEMBER STATES COLLECTIVE IGAD COLLECTIVE SOUTHERN AFRICAN DEVELOPMENT COMMUNITY SECDEF WASHDC USEU BRUSSELS 3153 USMISSION GENEVA USMISSION USUN NEW YORK UNCLAS SECTION 02 OF 04 ROME 000876 SIPDIS AIDAC FROM U.S. MISSION IN ROME AMEMBASSY ADDIS ABABA FOR AMBASSADOR BRAZEAL AND USAID DEPUTY DIRECTOR FREEMAN UNCLASSIFIED PAGE 02 ROME 00876 02 OF 04 040821Z USAID/W FOR ADMINISTRATOR NATSIOS, D/A SCHIECK, AA/DCHA WINTER, AA/AFR NEWMAN AND DAA/AFR BROWN, DCHA/D/FFP LANDIS, D/OFDA MCCONNELL, AA/GLOBAL PETERSON STATE FOR P U/S GROSSMAN, U/S LARSON, IO A/S HOLMES, A/S PRM DEWEY, A/S AFR KANSTEINER, AFR/EA, IO/EDA WINNICK USDA/FAS FOR U/S PENN AND CHAMBLISS USDA/FAS NAIROBI FOR KESSLER USMISSION GENEVA FOR AMBASSADOR MOLRY AND USAID/KYLOH BRUSSELS FOR AFRICA WATCHERS AND USAID/LERNER NSC FOR JDWORKEN AND AFRICA DIRECTORATE E.O. 12958: N/A TAGS: EAID AORC PREF EAGR AORC PREF EAGR AORC PREF EAGR AORC PREF EAGR EU WFP UN EU EAID WFP UN EU EAID WFP UN EU EAID WFP UN SUBJECT: THE LETHAL COMBINATION OF HUNGER AND HIV/AIDS IN ETHIOPIA AND SUB-SAHARAN AFRICA "THE WORLD KNOWS THAT HIV/AIDS IS FATAL. THE WORLD ALSO KNOWS THAT SOUTHERN AFRICA, WHERE SOME OF THE HIGHEST HIV PREVALENCE RATES ARE FOUND, HAS SUFFERED FROM SERIOUS FOOD SHORTAGES AFFECTING MILLIONS OF IMPOVERISHED PEOPLE. BUT THE WORLD CLEARLY DOES NOT YET REALIZE THE IMMEDIATE AND LONG - TERM IMPLICATIONS OF A CRISIS CAUSED BY THE CONJUNCTION OF HIV/AIDS WITH CHRONIC POVERTY, ERRATIC RAINFALL, PROBLEMATIC GOVERNMENT POLICIES AND NATURAL RESOURCE DEGRADATION, OR THE URGENT NEED IT SIGNALS FOR A PROFOUND SHIFT IN HUMANITARIAN AND DEVELOPMENTAL STRATEGIES. IN THE SIX COUNTRIES CURRENTLY SUFFERING FOOD SHORTAGES IN SOUTHERN AFRICA, THE HIV/AIDS PANDEMIC IS ENDANGERING THE LIVES AND LIVELIHOODS OF MILLIONS OF PEOPLE AND UNRAVELLING UNCLASSIFIED PAGE 03 ROME 00876 02 OF 04 040821Z THE SOCIAL FABRIC OF SOCIETY TO THE EXTENT THAT THE STABILITY AND SECURITY OF THE REGION AS A WHOLE IS AT RISK. ONLY RECENTLY HAVE THE GOVERNMENTS OF SOME OF THE MOST AFFECTED COUNTRIES IN SOUTHERN AFRICA BEGUN TO COMPREHEND THE CRISIS THAT IS UPON THEM - A REALITY THAT HAS DRIVEN SOME POLITICAL LEADERS IN THE REGION TO SPEAK OF THE THREAT OF EXTINCTION. IT HAS TAKEN THE LOUD EMERGENCY OF A SEVERE FOOD SHORTAGE AFFECTING 15.1 MILLION PEOPLE TO DEMONSTRATE TO THE UNITED NATIONS AND ITS PARTNERS THE INSIDIOUS POTENTIAL OF HIV/AIDS TO UNDERMINE ENTIRE SOCIETIES AND NATIONS AND TURN CRISES INTO CATASTROPHES." END QUOTE. WILL WE BE WRITING A SIMILAR COMMENT ABOUT ETHIOPIA ONE-TWO YEARS HENCE? -------------- -------------- NEXT STEPS FOR UN AGENCIES FROM BOTH THE MORRIS/LEWIS AND US MISSION PERSPECTIVE -------------- -------------- ¶6. SOME KEY RECOMMENDATIONS FOR THE UN AGENCIES FROM THE MORRIS/LEWIS REPORT ARE AS FOLLOWS: A) THE UNITED NATIONS MUST PROVIDE A POWERFUL AND ENERGIZING LEADERSHIP, AT THE HIGHEST LEVELS OF THE AGENCIES, FUNDS AND PROGRAMS, IN ORDER FOR THE PANDEMIC TO BE CONFRONTED URGENTLY AT COUNTRY LEVEL. NOTE: US MISSION ADDS THAT THIS NEEDS TO BE DIRECTLY REFLECTED IN THE UN COUNTRY DEVELOPMENT FRAMEWORK (UNDAF). END NOTE. UNCLASSIFIED PAGE 04 ROME 00876 02 OF 04 040821Z B) UN SHOULD CONSIDER REVISITING PREVIOUS METHODS OF SHORING UP GOVERNMENTS AND POPULATIONS IN CRISIS -- INCLUDING DIRECT CASH ASSISTANCE TO COMMUNITY-BASED ORGANZATIONS THAT SUBSIDIZE SOCIAL SECTORS, AND DIREC SUPPORT TO MINISTRIES, ORGANIZATIONS AND INSTITUIONS THAT ARE LOSING THE HUMAN RESOURCES AND SKILED PROFESSIONALS REQUIRED TO FUNCTION EFFECTIVEY. C) DUE TO HIV/AIDS, THE NUMBERS OF CHRONICALY FOOD INSECURE AND THOSE REQUIRING NUTRITIONAL UPPORT CAN BE EXPECTED TO INCREASE OVER THE LONG TERM. THERE IS A NEED TO EXPLORE AND INSTITUTIONALIZE ALTERNATIVE MECHANISMS THAT PROVIDE ACCESS TO SUFFICIENT FOOD AND ADEQUATE NUTRITION. THIS SHOULD BE DONE IN WAYS THAT ENCOURAGE PARTICIPATION IN PROGRAMS DESIGNED TO OPTIMIZE SELF-RELIANCE AND STIMULATE LOCAL AND REGIONAL PRIVATE-SECTOR CAPACITY TO MEET DEMAND FOR FOOD. D) THE UNITED NATIONS SYSTEM MUST CONTINUE TO ADVOCATE AND UNCLASSIFIED UNCLASSIFIED PTQ7277 PAGE 01 ROME 00876 03 OF 04 040822Z ACTION SSO-00 INFO LOG-00 AF-00 AID-00 ANHR-00 E-00 UTED-00 TEDE-00 IO-00 NEA-00 NSCE-00 OIC-02 PM-00 P-00 SS-00 TEST-00 SA-00 PMB-00 PRM-00 SAS-00 /002W -------------- 3E8CE8 040822Z /38 P 040726Z MAR 03 FM AMEMBASSY ROME TO AMEMBASSY ADDIS ABABA PRIORITY SECSTATE WASHDC PRIORITY 8541 USDA FAS WASHDC PRIORITY 2577 INFO AMEMBASSY ASMARA AMEMBASSY NAIROBI EU MEMBER STATES COLLECTIVE IGAD COLLECTIVE SOUTHERN AFRICAN DEVELOPMENT COMMUNITY SECDEF WASHDC USEU BRUSSELS 3154 USMISSION GENEVA USMISSION USUN NEW YORK UNCLAS SECTION 03 OF 04 ROME 000876 SIPDIS AIDAC FROM U.S. MISSION IN ROME AMEMBASSY ADDIS ABABA FOR AMBASSADOR BRAZEAL AND USAID DEPUTY DIRECTOR FREEMAN UNCLASSIFIED PAGE 02 ROME 00876 03 OF 04 040822Z USAID/W FOR ADMINISTRATOR NATSIOS, D/A SCHIECK, AA/DCHA WINTER, AA/AFR NEWMAN AND DAA/AFR BROWN, DCHA/D/FFP LANDIS, D/OFDA MCCONNELL, AA/GLOBAL PETERSON STATE FOR P U/S GROSSMAN, U/S LARSON, IO A/S HOLMES, A/S PRM DEWEY, A/S AFR KANSTEINER, AFR/EA, IO/EDA WINNICK USDA/FAS FOR U/S PENN AND CHAMBLISS USDA/FAS NAIROBI FOR KESSLER USMISSION GENEVA FOR AMBASSADOR MOLRY AND USAID/KYLOH BRUSSELS FOR AFRICA WATCHERS AND USAID/LERNER NSC FOR JDWORKEN AND AFRICA DIRECTORATE E.O. 12958: N/A TAGS: EAID AORC PREF EAGR AORC PREF EAGR AORC PREF EAGR AORC PREF EAGR EU WFP UN EU EAID WFP UN EU EAID WFP UN EU EAID WFP UN SUBJECT: THE LETHAL COMBINATION OF HUNGER AND HIV/AIDS IN ETHIOPIA AND SUB-SAHARAN AFRICA SUPPORT GOVERNMENTS TO TAKE A MORE PROACTIVE LEADERSHIP ROLE WITH RESPECT TO COMBATING HIV/AIDS. THE REPORT RECOMMENDS THAT POSITIVE LEGISLATION BE INTRODUCED THAT PROTECTS WOMEN, AND THAT SOCIAL REFORM BE ENACTED THAT ADDRESSES THE BURDEN OF CARE CARRIED BY WOMEN. THE ROLE OF THE HIGHEST LEVELS OF GOVERNMENT IN LEADING A VISIBLE EFFORT AGAINST HIV/AIDS AND IN SUPPORT OF WOMEN CANNOT BE UNDERESTIMATED AND SHOULD BE ENCOURAGED. E) UNITED NATIONS AGENCIES NEED TO COMMIT THEMSELVES TO REVIEWING THEIR EMERGENCY AND DEVELOPMENT PROGRAMS IN AREAS OF HIGH HIV PREVALENCE THROUGH THE "LENS" OF HIV/AIDS. MOREOVER, AGENCIES SHOULD CONTINUE TO ADVOCATE WITH THEIR PARTNERS AND DONORS FOR THE NEED TO FULLY INTEGRATE HIV/AIDS INTO THEIR ACTIVITIES. UNCLASSIFIED PAGE 03 ROME 00876 03 OF 04 040822Z ¶7. IN US MISSION'S VIEW, UN AGENCIES CAN ALSO ASSIST IN STRUCTURING EFFECTIVE HIV/AIDS STRATEGIES, AS FOLLOWS: F) THE GLOBAL FUND TO FIGHT HIV/AIDS, TUBERCULOSIS, AND MALARIA - IS A KEY RESPONSE INSTRUMENT IN THE EVOLUTION OF GLOBAL HEALTH PROGRAMS PRODUCING MORE EFFECTIVE RESULTS. THE UN IS URGED TO ASSIST, AND WHERE APPROPRIATE PLAY A LEAD ROLE, WITH HOST GOVERNMENTS IN MAKING SURE THAT AN EFFECTIVE COUNTRY COORDINATION MECHANISM (CCM) IS IN PLACE. G) ALL MAJOR UN INTER-AGENCY MEMORANDA OF UNDERSTANDING (MOUS) (BETWEEN UNICEF, UNHCR, WFP, WHO, ETC.,) SHOULD BE REVIEWED TO ENSURE AND EXPAND THE COLLABORATION RELATED TO TARGETING FOOD INSECURE HIV/AIDS-PRONE OR AFFECTED POPULATIONS IN EMERGENCY SITUATIONS. H) BOTH THE UN AND THEIR NGO PARTNERS NEED TO QUICKLY INTENSIFY AND EXPAND ACTIVITIES TO STRENGTHEN HIV/AIDS INFORMATION CAMPAIGNS, CARE FOR ORPHANS, AND TRAINING FOR SERVICE PROVIDERS TO BETTER MANAGE THIS PANDEMIC. I) UN PARTNERS NEED TO COME TOGETHER IN ESTABLISHING STANDARD INDICATORS AND METHODS FOR INCORPORATING HIV/AIDS IN FOOD SECURITY, CROP AND VULNERABILITY ASSESSMENTS. MORE AND BETTER ESTIMATES OF THE MACROECONOMIC EFFECTS OF AIDS IN COUNTRY ARE NEEDED IN ORDER TO FULLY UNDERSTAND AND ADDRESS ITS DEVASTATING IMPACT. J) UN AGENCIES (WFP, UNICEF, FAO) ARE ENCOURAGED TO WORK ALONG WITH WORLD HEALTH ORGANIZATION (WHO) TO ACCELERATE THE UNCLASSIFIED PAGE 04 ROME 00876 03 OF 04 040822Z REVIEW OF EXISTING MATERIAL ON "HIV/AIDS AND NUTRITION" AND DEVELOP JOINT UN GUIDELINES. K) UN AGENCIES ARE URGED TO BECOME FORCEFUL ADVOCATES WITH PARLIAMENTARIANS AND OTHER STAKEHOLDERS IN EVERY COUNTRY TO DEVELOP NATIONAL POLICIES FOR ORPHANS AND INNOVATIVE COMMUNITY-BASED PROGRAMS TO PROVIDE CARE AND SUPPORT FOR CHILDREN AND FAMILIES IN NEED. -------------- AMBASSADOR HALL'S COMMENT -------------- ¶8. MY RECENT TRIPS TO SOUTHERN AFRICA (REFS B AND C) AND TO ETHIOPIA HAVE BROUGHT HOME TO ME THE RECENT COMMENT OF DR. PETER POIT (UNAIDS CHIEF) THAT "HIV/AIDS IS RAPIDLY WIPING OUT DECADES OF DEVELOPMENT AND CONTRIBUTING TO REGIONAL INSTABILITY. THE CASE FOR INCREASING ACTION AGAINST THIS EPIDEMIC HAS NEVER BEEN STRONGER OR MORE URGENT." I SEE A GROWING NEGATIVE SYNERGY BETWEEN AIDS AND FAMINE, AS FEWER UNCLASSIFIED UNCLASSIFIED PTQ7279 PAGE 01 ROME 00876 04 OF 04 040822Z ACTION SSO-00 INFO LOG-00 AF-00 AID-00 ANHR-00 E-00 UTED-00 TEDE-00 IO-00 NEA-00 NSCE-00 OIC-02 PM-00 P-00 SS-00 TEST-00 SA-00 PMB-00 PRM-00 SAS-00 /002W -------------- 3E8CEF 040822Z /38 P 040726Z MAR 03 FM AMEMBASSY ROME TO AMEMBASSY ADDIS ABABA PRIORITY SECSTATE WASHDC PRIORITY 8542 USDA FAS WASHDC PRIORITY 2578 INFO AMEMBASSY ASMARA AMEMBASSY NAIROBI EU MEMBER STATES COLLECTIVE IGAD COLLECTIVE SOUTHERN AFRICAN DEVELOPMENT COMMUNITY SECDEF WASHDC USEU BRUSSELS 3155 USMISSION GENEVA USMISSION USUN NEW YORK UNCLAS SECTION 04 OF 04 ROME 000876 SIPDIS AIDAC FROM U.S. MISSION IN ROME AMEMBASSY ADDIS ABABA FOR AMBASSADOR BRAZEAL AND USAID DEPUTY DIRECTOR FREEMAN UNCLASSIFIED PAGE 02 ROME 00876 04 OF 04 040822Z USAID/W FOR ADMINISTRATOR NATSIOS, D/A SCHIECK, AA/DCHA WINTER, AA/AFR NEWMAN AND DAA/AFR BROWN, DCHA/D/FFP LANDIS, D/OFDA MCCONNELL, AA/GLOBAL PETERSON STATE FOR P U/S GROSSMAN, U/S LARSON, IO A/S HOLMES, A/S PRM DEWEY, A/S AFR KANSTEINER, AFR/EA, IO/EDA WINNICK USDA/FAS FOR U/S PENN AND CHAMBLISS USDA/FAS NAIROBI FOR KESSLER USMISSION GENEVA FOR AMBASSADOR MOLRY AND USAID/KYLOH BRUSSELS FOR AFRICA WATCHERS AND USAID/LERNER NSC FOR JDWORKEN AND AFRICA DIRECTORATE E.O. 12958: N/A TAGS: EAID AORC PREF EAGR AORC PREF EAGR AORC PREF EAGR AORC PREF EAGR EU WFP UN EU EAID WFP UN EU EAID WFP UN EU EAID WFP UN SUBJECT: THE LETHAL COMBINATION OF HUNGER AND HIV/AIDS IN ETHIOPIA AND SUB-SAHARAN AFRICA AND FEWER FARMERS ARE AVAILABLE TO WORK THE FIELDS. FAO TELLS US THAT SEVEN MILLION FARMERS HAVE ALREADY LOST THEIR LIVES TO AIDS IN AFRICA. IT IS CLEAR THAT EVERY UN ORGANIZATION INCLUDING THOSE WHICH WE WORK WITH HERE IN ROME - AND ALL OF US NEED TO INTENSIFY OUR EFFORTS. HALL UNCLASSIFIED > 2003ROME00876 - Classification: UNCLASSIFIED