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Feminist Majority Foundation Chat Series of 2003

KIM NICHOLS, African Services Committee
Wednesday, March 5, 3-4 pmEST

Part of the March Series: Global Women's Voices, HIV/AIDS Speakers

Kim Nichols

Kim Nichols is on the boards of the Global Fund to Fight AIDS, UNAIDS and
the Global AIDS Alliance, and has been involved in both New York City and global AIDS advocacy for the past 18 years. Having lived and worked in Ethiopia, Kenya, Sudan and Guatemala, Kim has a wealth of experience in the design, development and implementation of community health programs. She is also particularly interested in debt cancellation for poor countries as a source of funding for HIV/AIDS control efforts.

Kim is currently Co-Executive Director at the African Services Committee , a 22 year-old NGO that has developed effective programs in HIV, tuberculosis, and STD testing, prevention and care, in HIV/TB housing, legal advocacy, food and nutrition and micro-enterprise development. Her professional training is in nutrition and infectious diseases.

David Bryden: Hello Everyone. My name is David Bryden. I work as the Communications Director at the Global AIDS Alliance. I will be moderating today's chat. I would like to thank Kim Nichols for joining us in the chat today.

Kim Nichols: Thank you, David. it is a pleasure to join you and I hope that I'll be able to shed some light on some of these important questions regarding global AIDS policy and funding.

James: What are some of the challenges facing the Global Fund?

Kim Nichols: Insufficient financial resources, stemming from lack of political will at the highest levels of government in the G-8. Also-lack of political will in many of the recipient countries to involve meaningful participation of civil society, especially NGOs, in the development of Global Fund proposals and in the implementation of national and local programs funded by the Global Fund.

Lisa: Can you describe what it has been like to participate on the board of the Global Fund?

Kim Nichols: I am actually on a delegation to the Board of the Communities Living with HIV, TB, and Malaria. As a community NGO person, it has been interesting and challenging to merge my way into discussions which are often limited to heads of state, multilateral institutions (World Bank, other UN agencies,etc.) The community members on this board are very active and there has been great movement to incorporate our viewpoints into the implementation of the Global Fund framework.

Rita: What has been the involvement of corporations in the Global Fund?

Kim Nichols: The private sector, including corporations, have given only a small proportion of the funds donated to date to the Global Fund. The majority of the funds pledged to date (2.2 Billion through 2006) come from donor governments. The Global Business Coalition on HIV/AIDS, which has recruited some 70 major corporations as members, has not been in the business of raising money for the Global Fund; rather they have helped these corporations develop sound workplace policies on HIV/AIDS, develop corporate commitment and guidelines for treatment of workers and families with ARV therapy, etc.

Jeff: As someone who is well connected at the highest levels of global politics (UNAIDS, the Global Fund, etc.), do you think rich countries will ever agree to cancel developing country debts to the extent needed to make a real difference? If yes, what is your sense of the timeframe--how is the issue progressing--and how should the money saved be put to good use? If no, why not?

Kim Nichols: This is a great question. Rich countries may only agree to cancelling developing country debts when it becomes clear that the infrastructures in those countries are so bankcrupt that foreign capital investment and use of developing country labor to milk that capital may no longer be possible. I think in the case of Africa, the HIV epidemic will take such a great toll on investments that debt repayment may someday soon be acknowledged by the bilaterals and multilateral lenders as insupportable.

Kevin: Seeing that you have lived and worked in Africa and Central America, have you seen any similarities or differences with how local communities in Africa tackle HIV/AIDS issues compared to local communities in Central America?

Kim Nichols: I lived in Guatemala just prior to the recognition of the HIV epidemic-left in 1980. I hear from friends who are working in CA as project officers that communities there are getting quite organized, particularly networks and organizations of people living with HIV- and treatment is beginning to become available in this region.

April Sjovall: I was wondering if the prevalence of HIV and AIDS in africa is not at least by a good margain due to FGM?

Kim Nichols: Well here's a question which has been discussed in public health circles since Africa and HIV epidemic came onto our radar. It is acknowledged that surgical procedures with shared, non-sterile instruments has certainly played a role in the transmission of HIV, and it is also true that in many countries in Africa, over half of the female population has been circumcized or infibulated, often in circumstances where instruments are not sterilized between use.

jacques du guerny: Why after the UN Div for Advancement of Women and the Commission on the status of women alerted women to the danger of HIV/AIDS and its gender dimensions in 1990/91, was this work mostly abandoned and several years lost for women to protect themselves?

Kim Nichols: That's another great question. The UN declarations and reports often fail the test of adoption, implementation. But the UN Commission was not the only body to fail in protecting women from HIV/AIDS. Health department, charged with protecting the health of people from deadly diseases, even in wealthy countries and rich cities, failed to protect women from becoming the next wave in the HIV epidemic. This occurred right here, in NYC, where I live. 1990/1 was the juncture at which the epidemic really, in retrospect, starting affecting women in the US. Women elsewhere, in the developing world, for ex, were already heavily affected, as we know today. Again, a question of political will for implementation, and also a question of denial. One population after another has fallen to HIV thanks to denial.

Lynn Martin: Are you familiar with a group of hiv positive women in Uganda called Taso Malago? I think that's the correct spelling thanks

Kim Nichols: Yes, the AIDS Service Organization of Uganda. One of the original and now best established African AIDS NGOs. Sophia Mucasa Monico, who will be on the chat later- maybe tomorrow?- formerly worked with TASO.

Julie Mikalson: A research MD recently told me that there is not adequate technology to move forward larger scale Clinical Trials for AIDS treatment in Africa. I would like to focus energy on a demonstration project, for a new Chinese medicine shown to be effective in reducing the viral load - in smaller scale Trials in both humans and animals. I understand there is a need for secure facilities and equipment sufficuent to conduct HIV blood assays. Can you suggest ways I might stimulate action around Technology Transfer for this purpose? Thank you for your work!

Kim Nichols: Julie-it is true that the technology for developing clinical trials for AIDS vaccines and therapies require the support of laboratory facilities which are relatively few and far between in Africa. Generally the developers of these trials are either based outside the African continent, or have research partners based in developed countries who can help support technology needs for analysis of clinical results. In the area of traditional Chinese medicine, there is a group in Boston which has started the Pan-Africa Acupuncture Project (out of the NE School of Acupuncture and a local hospital or clinic) They might be able to tell you more about TCM and diagnostics available to monitor VL and other clinical results. Roche Diagnostics has been providing its viral load test to most of the vaccine trials in Africa and to some of the ARV studies.

Michelle Dixon: What role to you see the Global Fund as playing in promoting and ensuring access to medicications? Does the Fund have a position on curent trade negotiations as they relate to this issue?

Kim Nichols: Greatest question. The GF must STRONGLY encourage application of eligible countries for commodities. As it stands, more than 50% of requests for Fund dollars are currently for commodities, which include malaria and TB meds, bednets for malaria prevention, and a very small subset of requests for HIV medications. This is beginning to change, but without NGO/activist involvement in the proposal design and project implementation process, I fear will lag badly. Up to now, during first 2 GF rounds, countries have been shy about asking for ARV for HIV, though the second round requests increased greatly. the Fund can only encourage best practices, in this case the implementation of wide-scale ARV programs in the hardest hit countries, and as there is no upper limit in place on grant size, countries can feel free to propose ARV procurement in their plans. However, procurement also requires good supply chain management, quality assurance, etc. The fund's position on IP re: medications is that the DOHA interpretation of the WTO is acceptable grounds for procurement of drugs via parallel importing or local manufacture of off-patent drugs.

David Bryden: Now that Bush has made his proposal on AIDS what happens next? Is there any way the average person can influence the process so the Global Fund does not reach a financial meltdown thanks to the stinginess of the US, Europe and Japan and others?

Kim Nichols: Important. The GF is short nearly 500 million as it goes into releasing the announcement for the Third Round of GF applications. Bush's proposal of $15 Billion - $10 Billion of it in "new" money for global AIDS will go almost entirely to bilateral channels-which is where the meager US contribution for global AIDS has been primarily channeled since it began in the 90's. Bush's new pledge actually give less to the GF than it is currently giving (will give $200 million per year over 5 years-the 2002 contribution was $250 million). The average person can use legislative vehicles, such as pressure on their local elected officials, to up the US contribution to $3.5 billion for FY 2003 emergency supplemental funding and $3.5 Billion for FY 2004. Of this, at least $1.7 Billion should go to the Global Fund. And where the US leads, other members of the G-8 will follow.

Michelle Dixon: I was asked in a meeting with a Sentate staff member if the focus on AIDS within the Global Fund has conflicted with or decreased funding and support for TB related activities and I didn't have an adequate answer. Could you shed some light on this question for me?

Kim Nichols: This question is difficult for me to answer. I can only tell you that within the GF, there has been some jockeying for disease superiority. E.g, the number of specialists who review GFproposals who have a TB background was recently decreased, in favor of having more reviewers with a cross-cutting background (HIV/TB/Malaria) But that doesn't speak to how GF proportionately greater emphasis on HIV may have affected TB funding

David Bryden: Have any of the candidates for President in the United States identified global AIDS as a key issue?

Kim Nichols: I have not heard any public statements of candidates about global AIDS as a campaign issue. I know that my colleagues from HealthGAP, and others, are planning to start chasing them in NH once the campaigning begins, to ensure that they start taking a stand on global AIDS issues early on.

Jim Steed: Kim, I live in London. Is there anything I can do to help the Global Fund?

Kim Nichols: Talk to Int'l HIV/AIDS Alliance. Kieran Daly there is a member of the Northern NGO Delegation to the GF. He perhaps can help you identify ways in which advocacy directed towards the British govt could increase their contribution to the GF. The British delegation to the GF are generally pretty progressive. Folks from DFID are well-represented at the there.

james m nordlund: If the roots of lack of compassion for the diseased and the en vogue economic tool war, one being psycho-pathic greed, aren't addressed in Western societies sociological programming of their populaces, won't the corporate structure's convolution's devolutionary direction eventually determine more apathy and social pathos in global society; ergo less funding for prevention, treatment, and research into curing AIDS, in the longrun?

Kim Nichols: I keep circling round this question. Corporations CAN be brought on board to help us here. It's just that when it comes to public health/AIDS and human rights, they have a track record largely of being on the wrong side. We need to keep pushing them, engaging them to understand the end-consequences of their greed-LOSS of PROFITS!

Reid: I have just recently completed Joesph Stiglitz's book on globalization. If it is all true, than the IMF has been a major contributor to poverty and health issues like the spread of HIV/AIDS. What is the IMF doing now in this area? Is making any positive contributions?

Kim Nichols: I'm not aware of IMF's contributions to fighting HIV/AIDS, but that doesn't mean they don't exist. The debt cancellation folks and others interested have lobbied long and hard for the abolition of structural adjustment policies which attach use fees to health care, education, and access to other public works. The IMF is beginning to let up on the SAPS. The WB is now giving loans ($1Billion) for HIV/AIDS programming in hardest-hit countries, through its MAP program. But these are loans, in countries which collectively are paying back already nearly $14 Billion per year to IMF/WB!

Linda Kuruhara: What is the best way for a church to be a voice in this effort to reduce debt and aids relief?

Kim Nichols: Call Jubilee USA Network in Washington, and pledge to support their campaigns through your churches!

David Bryden: Thanks Kim for taking the time to share your ideas with us. I would also like to thank all those who participated in the chat. We would appreciate your feedback about the chat. Please go to to take a 2 minute survey. On the website, enter 4130 under "Take a Survey." Thank you very much for your participation and feedback.

Kim Nichols: Thanks, David. For all of you who are interested in the US legislative avenues possible to redress the painful lack of funding for Global AIDS by this Administration, please go to\cd_action.html (Global AIDS Alliance), which has been a leader pushing our government to put its share to fighting the global AIDS epidemic forward.

Michelle Ruiz: Kim - let me ask you, as a feminist what is your take on the gag rule, I mean where the US says it will not give money to programs that mention or even provide abortion as an option to women in family planning. I am not a big promoter of abortion but I think women need to know the fact and be able to decide for themselves. Could the gag rule be applied to AIDS programs the US supports and how would that affect them?

Kim Nichols: Are we still on? The global gag rule in fact is already affecting US contributions to UN agencies which provide important HIV prevention programs in the developing world, such as UNFPA, which provides all kinds of reproductive healthinterventions, as well as condoms. It's certainly affected Planned Parenthood International.

David Bryden: Now that Bush has made his proposal what is the role of congress and how can we have an impact on congress?

Kim Nichols: I wanted to correct the URL I just gave for Global AIDS Alliance. It should read: I refer you to GAA to look at their "Roadmap for Legislative Action to Stop Global AIDS"

Karina Lopez: Kim, it's incredible to me how President Bush could say he wanted emergency action to fight AIDS but in the fine print of his plan it's anything but fast action. Is there anything Congress can do to speed things up -- what about providing money right away to the Global Fund? Or will the fervor for war among many in Congress distract them from this crisis?

Kim Nichols: This is my last question- Emergency supplemental funding of $3.5 Billion for global AIDS for 2003 would be the right thing for Congress to do. Really, the fervor for war among many of the Democrats in Congress seems to just fill the void created by their lack of energy for other areas of global concern, such as health and development. Let's get them on a positive track to re-building human societies, rather than destroying them.