Donor funding for global AIDS 
Africa’s Fight in Peril

Just as scientific advances suggest that we can end the pandemic, broken promises and retrenchment of donor funds threaten progress

For the first time since 2001, international funding for HIV is falling

For the first time since 2001, international funding for HIV is falling

IN 2000, almost no one in Sub-Saharan Africa had access to life-saving antiretroviral therapy (ART) that had already transformed HIV/AIDS from a death sentence into a manageable chronic condition in wealthy countries. Over the last decade, as a result of sustained pressure from activists and the falling prices of ART, there has been an unprecedented mobilization of financial resources and political will to expand access to these treatments. As a result of this, the Joint United Nations Programme HIV/AIDS (UNAIDS), estimated that by the end of 2011, 6.6 million people in
developing countries were on treatment. Additionally, the number of AIDS-related deaths is declining globally, and the rate of new infections has fallen by more than 25% over the past decade. However, the fight is far from over. Today there are 34 million people living with HIV worldwide, two-thirds of these in Sub-Saharan Africa. Approximately 7.6 million people (or more than half of those who require them) are without the medications they need to stay alive, and only 48% of pregnant women with HIV in developing countries are receiving treatment to ensure that the virus is not passed on to their children.

In May 2011, scientists announced that people living with HIV who adhered to treatment were 96% less likely to pass on the virus, based on results of the HPTN052 randomized control trial. Other trials have also demonstrated that antiretroviral drugs and male circumcision have significant protective effects for people who are not HIV-positive. Economic modelling undertaken by the U.S. Centres for Disease Control demonstrates that substantial investments in Sub-Saharan Africa will not only significantly reduce the incidence of HIV but also offset the cost of scaling up treatment and care by almost 60%. In its 2011 global report UNAIDS set goals of zero new infections and zero AIDS-related deaths – targets that they believe are achievable in the not-so-distant future. In a letter to partners, UNAIDS Executive Director Michel Sidibé urged that “together, we can make this the defining decade, the decade that signals the beginning of the end of AIDS”.

Brake on Progresss

Ironically, for the first time since 2001, international funding for HIV is falling. The two largest international donors, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis and Malaria, have both recently revealed worrying retrenchments. At the end of 2011, in an unprecedented move, the Global Fund announced that it was cancelling its next round of funding due to the failure of wealthy governments to deliver on their commitments. Also, despite promising to work towards the realization of an “AIDS-free generation”, the Obama administration has proposed an 11% cut in funding to the PEPFAR program next year. By reducing or even flat-lining investments in expanding treatment access, donors are threatening to pull the brakes on this fight.

When asked about the reasons for this reneging on aid commitments by wealthy nations, Dr. Jennifer Cohn, international HIV policy expert and Assistant Professor in Infectious Diseases at the University of Pennsylvania said: “I think some has to do with the global economic downturn, but it also has to do with donor fatigue and the fact that governments view foreign assistance as expendable.” According to Cohn, this back-pedalling by international donors is already having an effect on some of the most vulnerable states on the continent. In 30 African states, donor funds account for more than 70% of expenditure on HIV treatment and care. In countries like Uganda and Mozambique, caps have been imposed on the numbers of people that can be put on treatment, and there are reports of a shift in donor funds from recurrent expenses to one-off investments.

A moral obligation

While governments in low and middle-income countries must most certainly be held accountable for increasing domestic resources to address the pandemic within their own borders, some believe that donor governments have a moral obligation as well: “The reality is that those cuts, as devastating as they are to these communities, will never balance the budgets of the richest countries in the world. They are not necessary cuts. Fundamentally, they are political choices. African communities have become collateral damage in an effort by some donors to attempt to step away from a commitment that they made as members of the international community. I think that our challenge as a global social movement to promote universal access to HIV treatment, to freedom from TB and protection from Malaria, as well as the human right to health, is to ensure that they don’t get away with it”, said Asia Russell, Director of International Policy for a U.S.-based HIV advocacy organization called the Health Global Access Project.

While activists around the world are enraged by recent retrenchments, Russell expressed hope that civil society could ensure that donors do the right thing: “We know that the cost of doing the wrong thing is astronomical. It is morally, politically and economically untenable. I think that is why even a sceptic can understand that, although we are facing a moment of acute challenge, this threat is something that is imminently surmountable.”