With different approaches countries, donors try to do the right thing

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Representatives of three countries and two donors  describe opportunities and challenges to making the most of scientific advances – and limited funds

Brazil seized the moment early, with activists pressuring government officials to build in a budget line for the then new treatment for AIDS in 1996.

“From then on every year, we didn’t have to discuss whether the money was there or not,” Brazil HIV/AIDS program director Dr.  Mariangela Simao said. Having allocated money freed the government and nonprofit organization planners to focus on spending it carefully – producing drugs at reduced costs, targeting key populations – and turning down money from the United States tied to the anti-prostitution oath, because it would have hindered efforts.

At an International AIDS Conference session Tuesday, Dr. Simao urged those representing other countries not to get caught in a cycle of research to prove what experience already has shown, particularly in addressing human rights issues connected to the epidemic .

“There isn’t time, and it’s the right thing to do,” she said.

The topic of the session was “Strategic Use of Resources: Doing the Right Things with the Right Money.”

But not all countries were at the same point, it was clear.

In Tanzania, officials had just begun to focus on determining the rates of anal sex – among men who have sex with men, and among women who have sex with men, Fatma Mrisho, chairwoman of Tanzania’s AIDS Commission said. “The information will help inform our strategy,” she said.

The country’s response is 95 percent donor dependent and with a 50 percent gap between the country’s estimated HIV/AIDS needs and its current funding, planners are now urgently focusing on eliminating parallel programs, coordinating programs, and seeking to identify “what works best.”

The President’s Emergency Plan For AIDS Relief is helping, Deborah Von Zinkernagel, United States Global AIDS said, working with countries to carry out expenditure analyses.

“It sounds like it should have been a no-brainer,” she acknowledged. But gathering data across programs and across countries, has been complicated, she added. But in countries the efforts pay off, she said, offering Mozambique, where she said expenditure per patient has declined 45 percent, since an expenditure analysis that began in 2009.

Zimbabwe, on the other hand, has seen slower progress, said Raymond Yekeye of  the country’s National AIDS Council said.

“We haven’t gone very far,” he said. Challenges that remain include the need to strengthen ways to track funding, examining the efficiency of programs, finding ways to reduce costs.

Still, he looked skeptical when Simao suggested that countries need to examine their responses to the needs of men who have sex with men.

While recognition of men who have sex with men can’t be addressed the same way in every country, it can’t be neglected, she said.

Finally, Marieke van Schaik, managing director of the Dutch Postcode Lottery, described a different way of finding – and using funds. The lottery, which, she said, is the world’s third largest private donor, uses the proceeds of lottery tickets to fund good works.

It has done so well, she said, that it has introduced “dream fund”  to support investments that are both “high risk” and potentially high impact. It has started with a project to roll out treatment of HIV as prevention, in Swaziland, with a goal of reducing new infections by half by 2020.

The dream fund approach offers an alternative to the wait and see approach of continued study and analysis, she said.

“Not everything can work,” she said  “but we can also show what doesn’t work.”

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