ABSTRACT
As AIDS became a more significant factor in Western perceptions of developing countries, it was reinterpreted from being understood as primarily a health issue to one with immediate and large scale consequences for development. There is now a large literature on both the economic impact of HIV/AIDS, and the larger implications for development programs,8 some of which is used as ammunition in the inter-agency battle for control of the epidemic. AIDS also became an issue for bilateral development programs, which almost all rich countries use as an arm of foreign policy. Again, a small number of northern European and North American countries contribute the great bulk of international aid monies targeted at HIV/AIDS (some such as France and Germany have used bilateral channels considerably more than multilateral). Most of the agencies in developing countries encountered in this book receive funding from government programs funded by the major agencies: the United States Agency for International Development (USAID); the Canadian International Development Agency (CIDA); the Swedish International Development Agency (SIDA); and the French government. With the addition of Germany, Denmark, and the European Economic Community, these have provided about 90 per cent of funds available for bilateral AIDS programs to date. 9 (On a per capita basis, the most generous have been the Scandinavian countries, Canada and Switzerland; although Japan is a major international donor this has not been the case vis-a-vis AIDS, which may be a reflection of the continuing Japanese resistance to acknowledging the seriousness of the issue.)
just a matter of money; those familiar with development programs know that it is possible to flood effective programs with too much external support, thus weakening their local base and destroying the very characteristics that drew them to the attention of the funders in the first place. (I have heard descriptions of such effects upon community-based AIDS work in India, Uganda, and Cote d'lvoire.) Much of the money marked for assistance is in fact consumed by expensive consultancies, feasibility studies and maintenance of the donor agency; the development agencies, whether government or NGOs, are at least in part a central sector of the AIDS industry. Local CBOs often complain that they cannot get funding for basic infra-structure, and that their activities are distorted by the imposition of patterns that have more to do with the funders' domestic needs than an understanding of local conditions. (Funders in turn point to lack of financial accountability in many local NGOs, and the need to have clear criteria by which to evaluate performance.) Nor are the priorities of funders necessarily those of people on the ground: there are frequent complaints that donors will support prevention but not care programs in poor countries.
