Speakers including Global Fund and UNAIDS officials, two African health ministers, a U.S. State Department official and a Nigerian woman living with HIV addressed a packed room on the thorny issue of finding the financial resources for universal access to HIV treatment, prevention and support. A number of speakers lauded the progress in the AIDS response to date and the instrumental role of the Global Fund to Fight AIDS, Tuberculosis and Malaria in that response. State Department official John Monahan assured the audience that the United States was “more committed than ever” to the global AIDS response and also articulated a commitment to use every American tax dollar wisely and to coordinate efforts with the Global Fund to avoid duplication of effort and services. But he also noted the need to be realistic and the need for other donors and the private sector to do more to get the job done.
The Lesotho Health Minister Dr. Mphu Ramatlapeng acknowledged that African countries need to do more and to live up the Abuja agreement to spend at least 15 percent of GNP on the health of their own people. She admitted that Lesotho had a way to go to meet this target but was getting close. Rwandan Health Minister Dr. Agnes Binagwaho countered with the argument that African governments were actually doing a great deal. She pointed out that there were significant health expenditures in other accounts of the Rwandan national budget that were not necessarily “counted” as health expenditures. For example, education and training for health professionals is a component of the education budget, but is clearly related to health. She also applauded the Global Fund and its model, which requires all sectors of society to develop an application and forge a path forward in responding to AIDS, TB and/or malaria. Binagwaho highlighted that Rwanda does provide universal access to HIV treatment and that she was confident they can reach the goal of reducing vertical transmission of HIV (from mother to child) to two percent by 2015.
The most dynamic and passionate remarks came from Morolake Odetoyinbo, CEO of the non-governmental organization Positive Action for Treatment Access in Nigeria and a woman living with HIV/AIDS. She argued that African nations were not doing enough to use their resources to care for their own people. She called it “shameful” that despite being a citizen of the sixth largest oil producer in the world, she must rely on the U.S. government for her lifesaving HIV drugs. Odetoyinbo also insisted that the private sector must do more, starting with major employers. It isn’t enough that these employers don’t fire or otherwise discriminate against their workers living with HIV/AIDS; they have a responsibility to pay for their care and treatment, she said, instead of allowing these workers to be treated in and by the public sector. She also challenged U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) in the context of the new partnership framework agreements to stay seriously engaged in HIV prevention and treatment in Nigeria and other countries. “PEPFAR cannot just become a technical assistance partner,” Odetoyinbo said.
Global Fund Director Michel Kazatzchine and UNAIDS Director Michel Sidibe closed the panel with some remarks about the sobering financial challenges that exist. The Global Fund fell significantly short of even its most modest demand projections in last year’s replenishment conference and translating pledges into contributions would not be easy. A significant number of countries that have historically contributed to the Fund have not yet pledged to do so. Sidibe pointed out that 53 percent of the current resources committed to the global AIDS response come from developing countries. He called for an expansion of the donor base to include vibrant emerging economies and also flagged the potential for innovative financing strategies like a levy on global financial transactions.