Health Action AIDS

US Funding to Fight Global AIDS

The Global Fund to Fight AIDS, Tuberculosis and Malaria

The Global Fund was created to finance a dramatic turnaround in the fight against AIDS, tuberculosis and malaria. These three diseases kill more than six million people each year, and the numbers are growing. This massive scaling-up of resources already supports aggressive interventions against all three. By funding the work of new and existing programs, the Global Fund works to save millions of lives, stop the spread of disease, and halt the devastation to families, communities and economies around the world.

Importance of the Fund

• As a partnership among governments, civil society, the private sector and affected communities, the Global Fund represents an innovative approach to international health financing. With adequate contributions, the Global Fund can finance many of the bold, comprehensive and scientifically sound proposals it receives from disease-burdened nations.
• The Global Fund is country-driven, which means that people who best understand their own needs make decisions about country priorities and responses to the diseases.
• Government agencies, NGOs, and community-based organizations receive money from the Fund. Current contributors to the Fund include governments, foundations, businesses and individuals.

Results

As of May 2005, Global Fund-financed programs were supporting 220,000 people on AIDS treatment, had provided tuberculosis treatment to 600,000 people, and had distributed 3.1 million insecticide-treated bed nets to protect against malaria. These numbers will rise significantly over the coming years.

The Global Fund expects the following outcomes from grants approved in the first four rounds after five years:

• Provide anti-retroviral therapy for more than 1.8 million people
• Provide health, education and other support for more than 1 million orphans
• Provide HIV voluntary counseling and testing services to 62 million people
• Detect 5 million additional cases of infectious tuberculosis
• Cure 3 million people through the internationally approved DOTS treatment strategy
• 24,000 new treatments of multi-drug resistent tuberculosis
• Deliver 264 million artemisinin-based combination drug treatments for drug-resistant malaria
• Finance 109 million mosquito bed nets to protect people from malaria

Accountability

• The Fund is transparent. Accepted proposals and grant agreements, as well as other information, are published on its website at www.theglobalfund.org. This transparency, along with the participatory process of formulating proposals, helps people monitor how the money is being used.
• The Fund approves only proposals that are technically sound and meet high programmatic and financial accountability standards.
• The Global Fund will cut off funding after two years for programs that are not effective.

Contributions to the Global Fund and the Funding Crisis

• As of November 2006, the Global Fund has approved grants for $6.6 billion through over 460 grants to 136 countries.
• In the sixth round of funding 85 new grants were approved totaling $846 million.
• 62 countries will benefit from new funding; 4 countries will receive Global Fund financing for the first time. Over half the grants will go towards fighting HIV/AIDS.

The US President's Emergency Plan for AIDS Relief (PEPFAR)

In his State of the Union address on January 28, 2003, President Bush launched the President's Emergency Plan for AIDS Relief (PEPFAR), with the goals of 1) treating 2 million people with HIV/AIDS, 2) preventing 7 million new HIV infections, and 3) caring for 10 million people infected with and affected by HIV/AIDS, including orphans and other vulnerable children. The President laudably proposed spending $15 billion over five years to achieve these goals. The plan incorporates some important life-saving strategies, including greatly increased levels of HIV testing, efforts to eliminate gender inequalities, strengthening local capacity for AIDS treatment, and eliminating HIV transmission in health care settings.

However, the plan raises the following concerns:

Insufficient Funding Levels

The President and Congress frequently budget and appropriate insufficient funding levels for both PEPFAR and the Global Fund. PEPFAR contributions should at least be in line to match the five year $15 billion contribution pledged by President Bush in 2003. The annual US contribution to the Global Fund should represent one third of the total amount raised for the Fund each year, given that the US represents one third of global wealth. Additionally, the US should play a leadership role in encouraging other donor governments to give generously to the Global Fund.

Delay of PEPFAR Funding for WHO-Approved Generic Medications

PEPFAR correctly recognizes that the United States should provide high quality medications at the lowest possible cost. The World Health Organization (WHO) has approved generic, less costly anti-retroviral medications for HIV/AIDS treatment. The United States has required that drugs purchased with PEPFAR funding must pass a separate review process conducted by the US Food and Drug Administration (FDA). This additional step  was widely criticized for slowing the roll-out of lifesaving drugs; however, progress has been made. The FDA approved nearly 30 generic AIDS drugs in 2006. Currently, 70 percent of antiretroviral drugs bought in Nigeria, Haiti, and Zambia are expected to be generic as compared to last year when just 11 percent of AIDS drugs in the program's 15 countries were generics.

Lack of Support and Legal Protections for Oppressed Populations

• PEPFAR recognizes the need to promote children's and women's rights. It supports legal assistance for children and families, but should also support efforts to meet basic needs, including nutrition, education, and shelter, which are vital components of a comprehensive HIV/AIDS prevention strategy.HIV/AIDS programs must include the judicial and legal framework to protect women's rights, including educating the public on women's rights; upgrading women's economic and legal status; enlarging women's and girls' access to health care, and assisting governments in preventing and prosecuting rape, sex trafficking and child prostitution.
• PEPFAR highlights the need for targeted interventions for vulnerable populations including commercial sex workers and men who have sex with men. To improve the chances of success, these interventions must also create a non-punitive and non-judgmental atmosphere so that human rights are protected, and that these groups are not driven underground with decreased access to health care.
• PEPFAR fails to include comprehensive sex education and condom distribution for the general population. PEPFAR instead gives disproportionate focus to abstinence-until-marriage programs, which have proven to be ineffective without complementary prevention strategies. Comprehensive sex education, on the other hand, tends to delay the initiation of sexual activity, reduce the number of sexual partners, and increase condom use. PEPFAR should use funds set aside for abstinence-until-marriage programs to promote norms against child marriage.
• PEPFAR must build durable health infrastructure and distribute AIDS treatment equitably. PEPFAR places a clear and refreshing emphasis on rapidly scaling-up access to AIDS treatment, though it does not recognize the need to develop and implement ways to ensure equity in treatment scale-up. Strategies are needed to ensure treatment for rural populations, the poor, and others who traditionally have had limited access to health services. PEPFAR must incorporate strategies to recruit and retain health professionals, and provide support for public health systems.
• PEPFAR does not support clean needle exchange and other harm reduction strategies to protect injection drug users from HIV transmission. Study after study has demonstrated that providing access to clean needles for injection drug users significantly reduces HIV transmission without increasing drug use. These programs are particularly important in Vietnam (the only PEPFAR country in Asia).