Tax, debt injustice threaten  global Aids response 

What you need to know:

  • Recognising the interconnectedness between rising debt burdens and declining domestic funding for health cannot be ignored, particularly in limited-resource settings like ours. 

We continue to commemorate this year’s World Aids Day (December 1), when there is much to celebrate and reflect upon in terms of significant progress made in the fight against Aids.

Ground-breaking advancements in testing and treatment have seen a decline in Aids-related mortalities and morbidities. But much more could be done.

It is important to confront the stark realities that persist--- systemic disparities, declining funding, and the enduring impacts of colonialism threaten our global commitment to end Aids as a public health threat by 2030. 

The statistics are sobering, with 39 million people currently battling Aids, 630,000 succumbing to Aids-related illnesses in 2022, and a staggering funding gap of 29.3 billion by 2025, as reported by UNAIDS. 

The pressing questions persist: Why has Aids not ended? How can the international community ensure the Global South doesn’t lag behind in the global Aids eradication agenda? 

We all remember earlier in the year when Uganda’s Aids funding was in jeopardy because donors had decided to pull out. Why does something as vital as our people’s access to ARVs or access to healthcare depend on donors? 

In addressing these questions, it is crucial to recognise that without addressing global systemic issues that exacerbate health inequities, including debt, taxation, and intellectual property regime among others, we cannot make significant progress in the fight to curb HIV/Aids. 

Recognising the interconnectedness between rising debt burdens and declining domestic funding for health cannot be ignored, particularly in limited-resource settings like ours. 

The economic architecture has sustained a cycle of dependence on donor support and extractivism leaving low-income countries like Uganda highly indebted and at the whims of global financial powers. 

Debt is not a neutral economic factor but a construct of colonialism, as aptly put by Thomas Sankara, a Pan-Africanist and former President of Burkina Faso ‘… those who lend us money are the ones who colonialised us...’, emphasising the urgent need to deconstruct the existing historical and structural injustices that continue to shape global economic policies. 

We must pay attention to our rising debt because more is spent on debt financing than we spend on health and these repayments to creditors are diverting resources needed to fight scourges like HIV/Aids.

As UNAIDS research has found, the countries that are most highly indebted are the ones most affected by HIV/Aids.

Moreover, the current tax system exacerbates the challenge, facilitating illicit financial flows that deprive developing countries of crucial revenues for strengthening public health systems.

ISER’s research on Curbing Illicit Financial Flows to Fund Public Services found that Uganda lost the equivalent of half of its 2021 budget in illicit financial flows. 

The recent vote for the 2023 UN resolution on promoting inclusive and effective international cooperation by most developed countries can enhance the global solidarity and cooperation we need to curb illicit financial flows, make the wealthy and multinational companies pay their fair share of tax so as to get more resources for healthcare. 

Ending Aids requires much more than testing, treatment or viral control. States and international development partners must adopt an intersectional and inequality analysis to identify, reduce, and end inequities that represent barriers to people living with and affected by Aids, as emphasised in the UNAIDS global Aids strategy 2021-2026.

This is so because the impact of Aids is not homogenous, with disproportionate effects on women, children, persons with disabilities, and ethnic minorities. So, an inequality lens lays the foundation for co-creating interventions that are not only inclusive but responsive, effective, and leave no one behind.

The time is now for states, international development partners, and the global community to commit to dismantling systemic barriers, address historical injustices, and prioritise community-led initiatives.

The fight against Aids requires collective effort, grounded in equity, justice, and solidarity. Tackling debt and tax injustice is key.

Labila Sumayah Musoke,
Programme officer-Right to Health Initiative for Social and Economic Rights, [email protected]