A/67/302 availability of sustainable international funding for health, recipient States should also take all possible steps to ensure domestic resource self-sufficiency in order to avoid overdependence on international funding. 27. International assistance is often conditioned on recipient States adopting policies in line with the social, political or economic interests and ideologies of donors. Conditional aid may require recipient States to implement specific health strategies preferred by donors in order to obtain funds. Donor-driven strategies, however, may not be aligned with the health needs of recipient States and may instead distort domestic health priorities. 20 For example, donor funds earmarked for abstinence-only programmes in AIDS-affected countries promote the benefits of abstaining from sexual activity until marriage, but are required to withhold valuable information about the health benefits of condoms and contraception on the premise that such information contradicts the message of abstinence. 21 Studies have found abstinence-only programmes to be ineffective in preventing HIV and that withholding information about contraceptives places young people at increased risk of pregnancy and sexually transmitted infections. 22 28. Another bilateral assistance fund directed towards combating HIV/AIDS, does not grant funds to organizations that do not have a policy explicitly opposing sex work. 23 However, sex workers are among the most high-risk groups for HIV and have played a critical role in combating HIV transmission. They must therefore be fully integrated into all HIV prevention efforts in order to ensure that interventions are responsive, sustainable and in line with the right to health. Donor States should therefore not be driven by social, political or economic ideologies when designing and implementing health interventions. In accordance with the right to health, donors should instead ensure that they implement the most effective health strategies available given the needs of the recipient State as articulated by local stakeholders. 29. In many instances, as a result of macroeconomic conditions attached to loans from international financial institutions, international assistance for health does not result in increased public spending on health, but is instead used by States to build up reserves. 24 Studies indicate that each additional $1 of aid for health adds only approximately $0.37 to health budgets in recipient States, and less than $0.01 in States under the advice of the International Monetary Fund. 25 For example, in order to meet health-related Millennium Development Goals, one State would have needed to increase its total revenue by 20 per cent and allocate 15 per cent of the increased amount towards health. 26 However, conditions attached to macroeconomic loans required the Ministry of Health to freeze health budgets moving forward.26 Restrictions on State health spending of this nature infringe upon the right to health __________________ 20 21 22 23 24 25 26 12-46101 Gorik Ooms et al., “Financing the Millennium Development Goals for health and beyond: sustaining the ‘Big Push’”, Globalization and Health, vol. 6, issue 17 (October 2010), p. 3. Elaine Murphy et al., “Was the ‘ABC’ Approach (Abstinence, Being Faithful, Using Condoms) Responsible for Uganda’s Decline in HIV?”, PLoS Medicine, vol. 3, No. 9 (September 2006), p. 1445. Heather Boonstra, “Advancing Sexuality Education in Developing Countries: Evidence and Implications”, Guttmacher Policy Review, Summer 2011, vol. 14, No. 3, p. 19. See footnote 21. See footnote 20. David Stuckler et al., “International Monetary Fund and Aid Displacement”, International Journal of Health Services, vol. 41, No. 1 (2011), p. 67, 70. Gorik Ooms et al., p. 4. 11