We Could End AIDS, But Will We?

Today is World AIDS Day. This year, perhaps more than any in the past, should be an opportunity to celebrate how far we’ve come in addressing HIV.  We know now how unequivocally effective HIV treatment is not just in prolonging and improving the quality of life for people living with HIV, but in preventing HIV transmission. The goal of virtually eliminating mother-to-child transmission is within reach, even in resource-poor settings. More effective HIV prevention strategies are being employed and marginalized communities who are often most at risk of HIV are more engaged in the HIV response than ever, ensuring that they have the support necessary to be able to prevent and treat HIV in their communities. At this time, when we say we could end AIDS, we actually know how to do it.

We could end AIDS, but will we? There are two things standing in the way: political will and the money to do it. These two barriers came into painfully clear view last week when the board of the Global Fund to Fight AIDS, Tuberculosis and Malaria announced that it was cancelling its latest call for applications for funding and adopted a set of drastic measures so that it could maintain funding for the essential services that it is currently supporting. At precisely the moment we've realized how to curb HIV, donors have left the Global Fund treading water, struggling to keep funding flowing to preserve the lives of those who are already on treatment.

The Global Fund was supposed to be a “war chest;” a well-resourced fund that could rapidly push large amounts of money out to well-performing, evidence-based and country-owned programs in order to enable a massive scale-up of the fight against AIDS, TB and malaria. In 10 years it has disbursed more than $18 billion dollars and has saved close to 8 million lives. It has put more than 3.3 million people on HIV treatment and has provided services to 1.3 million women to prevent mother-to-child transmission of HIV. It has built stronger health systems and increased civil society engagement. Its deep commitment to human rights and marginalized groups has resulted in policy change and scale-up of services for those who would otherwise not receive them. As a myriad of external evaluations have demonstrated, the Global Fund has consistently proven that is good value for the money.

We knew this crisis was coming, but many of us, myself included, were in denial that donor governments would let something falter that has so fundamentally changed the dynamic of the HIV response for the better. The Global Fund’s last replenishment conference in October 2010 resulted in pledges and projected resources of approximately $11.7 billion for the period 2011-2013. At that time, the Global Fund Secretariat had said it needed $13 billion just to continue programs it was already supporting.

Since the replenishment conference, it has become clear that a number of donors will not fulfill their pledges. At the moment, the Fund has just over $6.5 billion in confirmed pledges for 2011-2013 and close to $4.4 billion in tentative pledges for future years (some of which may be provided in 2012 and 2013). This falls far short of the projected $11.7 billion and even further short of the need. The U.S., for example, pledged $4 billion, but given increasing hostility toward foreign aid in Washington and the fraught deficit negotiations, the Fund will be lucky to receive $3 billion over the period. Japan, in the aftermath of the earthquake and tsunami, reduced its announced contribution to the Global Fund by two-thirds. The Netherlands cut its contribution by more than $40 million per year. Other governments such as Germany and Denmark have flat-lined their contributions. The Global Fund’s financial crisis has nothing to do with mismanagement of funds, but everything to do with donor governments withdrawing or flat-lining their support for the Fund at a time when we need more investment, not less.

Earlier this week Jeffrey Sachs and Stephen Lewis rightly pointed out that this is an issue of misplaced priorities on the part of donors that verges on the criminal. When it comes to waging war or bailing out banks, money can always be found. Just $2 billion dollars is needed to ensure that developing countries are able to continue to scale up effective HIV, TB and malaria services over the next two years. Just $2 billion is needed to make progress in treating the more than 9 million people who are still waiting for HIV treatment and prevent millions more new infections. In the scheme of things, this is not a lot of money; it’s less than 0.05% of the budget of the U.S. Government. But it is the very thing that is needed to make sure that the Global Fund can support countries to begin to bring about an end to AIDS.

So this World AIDS Day, instead of reflecting on our successes, we need to recognize that we haven’t done enough. We need to demand that donor governments do more. At the minimum, we need an emergency replenishment of at least $2 billion so that the Global Fund can reopen the door to new, ambitious applications and countries can get to the business of saving millions more lives. I for one don’t want to look back on 2011 as the year that we could have turned the tide against HIV, but didn’t.