Question: Is corruption in HIV/AIDS different from corruption in the health sector generally?

Answer: Corruption in HIV/AIDS does not seem substantially different from between corruption and the health sector generally. They share the same major sources of corruption: procurement in health infrastructure, misuse of public funds intended to be spent on health, and informal payments by patients to health workers for services supposed to be free. These forms of corruption are facilitated by corrupt administration, poor or inexistent monitoring mechanisms, and weak enforcement of regulations in the health sector.

What is different, however, is the scale of the HIV/AIDS epidemic: its mode of transmission, the stigma attached to the disease, the absence of a cure and its projected negative impact on the development prospects of some of the poorest nations.

Furthermore, AIDS can be prevented, and the suffering from the effects of an HIV infection or AIDS can be alleviated effectively, provided that, among other factors, the health system is free of corruption and other malpractices.

This means that corruption can occur in the prevention stage of HIV infections as well as in the treatment of HIV/AIDS as a disease.

Issues relating to corruption in the prevention of HIV infections:

• Misappropriation of funds earmarked for public education and awareness raising: Levels of new HIV infections are believed to be significantly reduced through comprehensive awareness-raising campaigns highlighting the sources of transmission and detailing how people can protect themselves and others from infection. However, the effectiveness of this approach can be seriously hampered by corruption, or by misappropriation of funds earmarked for prevention campaigns (as appears to have been the case in Kenya).
• Standards of healthcare: HIV/AIDS can be prevented through the exclusive use of sterile needles and surgical equipment, and the screening of blood and plasma donations. While relatively low-cost, these measures are sometimes ignored by health workers, who either do not have the means to sterilise equipment in line with medical standards (due, for example, to a corrupt procurement and/or distribution process), or who use non-sterile equipment as an additional source of income (demanding illicit payments from patients, or claiming money for the purchase of new equipment but diverting the money from its intended use).

Issues relating to corruption in the treatment of HIV/AIDS:

• Misappropriation of funds earmarked for treatment: Misappropriation of funds earmarked for HIV/AIDS treatment can happen on both the petty (small) and the grand (large) scale, with actions ranging from corruption in allocation of contracts for the building of new centres to corruption in procurement of medicines. In Zimbabwe, the director of the National Network for People Living with AIDS was found guilty, in 2002, of topping up his salary with funds misappropriated from the network. In 2003, the director of Kenya's National Aids Control Council was dismissed following similar allegations.
• Misappropriation of medication: The comparatively expensive nature of HIV/AIDS medication makes it vulnerable to the corrupt diversion of drugs. The market for counterfeit drugs (the replacement of genuine drugs with medically ineffective substances such as sugar) and the simple theft of drugs are rife. Re-sale in the industrialised world of HIV/AIDS drugs obtained at preferential prices in developing countries (as in Uganda), undermines the availability and effectiveness of treatmentd and hurts those unable to afford treatment at increased prices.
• Request for illicit payments for treatment: Corruption in healthcare often takes the form of health care professionals requesting informal payments and bribes for the delivery of services supposed to be free of charge. In the case of HIV/AIDS, this can include the administration of drugs, counselling and testing, and the quality and availability of treatment for both HIV/AIDS and related diseases.

Corruption can impede on the effectiveness of HIV/AIDS prevention and treatment in a variety of ways. However, it is not necessarily among the prime causes for the spread of the disease, since countries like Botswana, where corruption is comparatively less prevalent than in the rest of Africa, are nevertheless among those most affected by HIV/AIDS.

Yet, Botswana is also the African country commended by the United Nations AIDS program for its effectiveness in addressing the disease, through efforts to prevent transmission from mother to child, and by making drugs available. Though this is not sufficient to suggest a link between low levels of corruption and the effectiveness of a national response to HIV/AIDS (which will depend on a variety of factors), the effectiveness of public service delivery more generally does depend on the extent to which corruption is perceived to exist.

## This information comes from the U4 Helpdesk expert queries; it has been edited for this newsletter. To read the full response or view other questions and answers, please see: http://www.u4.no/Helpdesk