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UNAIDS: AIDS Funding Faltering at Critical Moment

VIENNA, Austria | Global AIDS leaders continue to call for sustaining and increasing HIV/AIDS funding in the face of the global economic crisis at the International AIDS Conference this week.

“For the first time we are seeing funding going down,” said Michel Sidibe, executive director for UNAIDS. “Through solidarity we have put 5 million people on treatment, it’s not the time to flat-line or scale down, it’s time to scale up.”

While the gains of the last decade have been immense by all accounts, the global goal of having universal access to HIV medications by 2010 was solidly missed. More than 10 million people still need drugs, just as commitment to the universal access target appears to be wavering.

A UNAIDS and Kaiser Family Foundation report released during the conference shows support by developed nations to low-income countries for HIV/AIDS programs decreased slightly from $7.7 billion in 2008 to $7.6 billion in 2009.

The Global Fund to Fight AIDS, Tuberculosis and Malaria, one of the major contributors to HIV programs around the world, is also heading into its next crucial three-year funding replenishment with uncertain prospects for high-income country pledges.

“We need a $17 billion, at least, replenishment to allow countries to continue to scale up their abilities,” Global Fund Executive Director Michel Kazatchkine said. “I’m hearing from donors, ‘You know we really are under severe budgetary constraints.'”

Kazatchkine said the budget allocations come down to a political decision and a question of political priority. It is still unknown what donors will be willing to bring to the table in the fall, he said, aside from a proposed $1 billion U.S contribution for 2011, which would be a cut from its $1.05 billion contribution in 2010.

President Obama has also drawn criticism from advocates here because he requested only a small increase in the PEPFAR budget for 2011.

Promoting partnerships

Along with the constant call for donor commitments in Vienna has come a new call for more shared responsibility by developing country governments, more innovation for financing and delivery of services, and new cost cutting mechanisms.

“We would like to see a change in the way PEPFAR and Global Fund programs are embraced and run by governments,” Ambassador Eric Goosby, U.S. Global AIDS coordinator, told reporters. He said recipient governments should sustain or increase their own financial commitment to the cause over time and build ownership.

“We cannot make only one part of the world responsible,” said Sidibe, citing some progress on budget increases for HIV/AIDS in Kenya and South Africa.

African governments pledged in 2001 to allocate 15 percent of their budgets to health, but the World Health Organization reports that only six countries have met this commitment.

“AIDS is a matter of life and death. We can’t attack AIDS with only donor funds,” said Botswana’s former President H.E. Festus Mogae. “You can’t say something is a priority for you then say you will only do it if some other kind person gives you funding.”

Pushing efficiency and innovation

Doing more with the money that is available may be the biggest necessity of the future, said many of the experts at the conference, including Bill Gates, co-founder of the Bill and Melinda Gates Foundation, a major contributor of global health funds.

“Even if we advocate for more funding, we can do more to get the most benefit from each dollar,” Gates said in a speech to the conference.

Finding new efficiencies for prevention and treatment, as well as finding simpler diagnostics could cut costs, said Stefano Bertozzi, director for HIV at the Bill and Melinda Gates Foundation.

“You can also innovate on how you deliver,” he said. “How you supervise, who you train, who you can train at a lower level.”

Some of the innovative financing possibilities discussed at the conference to raise more funds included a small “Robin Hood” tax on financial transactions, which has been gaining traction recently, and a new initiative to offer people the option to donate to the cause whenever they purchase airline tickets online.

UNITAID is also building a new initiative to create a patent pool for HIV/AIDS drugs that are not available in a generic form to developing countries. Generic competition has reduced the cost of many first-line HIV medications by 99 percent in the last 10 years, said Ellen ‘t Hoen, senior advisor on intellectual property for UNITAID. But more people will need access to more expensive second-line drugs in the future, she said.

“One of the biggest challenges of today is how are we going to bring the prices down of the new medicines,” ‘t Hoen said. The pool, which is still being developed, would allow licensing of drugs to generic manufacturers, with royalties paid to the developing company.

The way forward

Sidibe attributes a lot of the new energy around alternative solutions and collaborations to the pressure and anxiety caused by the economic crisis, and a move from “a period of abundancy to forced austerity.”

“Vienna is an end, and a beginning of a new area,” Sidibe said. “The response now will need to be smarter, more strategic and more targeted.”

But Kazatchkine warned that innovative financing and efficiencies will not cover the resource gap to keep people on ARVs now and expand treatment in coming years.

“We are facing still an emergency situation,” he said. “[Money] in the short term is what will be necessary.”

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