The future of the AIDS response: A fragile affair

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“The 1,200 wealthiest people in the world have about $4.2 trillion in wealth,” said Kent Buse, a senior advisor on policy and strategy at UNAIDS. If that super elite group contributed 0.1 percent of their wealth, he said, it would pay for all of global health.

Buse opened what was a sobering discussion about the financial and political climate surrounding the movement to achieve universal access to HIV care and treatment Thursday at the International AIDS Conference (IAC) in Washington.

Although $24 billion is the expected global investment in HIV in 2015, that is still $7.2 billion shy of what is needed in low- and middle-income countries.  What’s the roadmap, Buse asked, to create universal access to HIV care not only in Africa, but every other region of the world, and how do we create the political incentive to encourage other countries to lead in that effort?

“Insufficient resources will affect our ability to reach our targets at the very time global south countries have shown their resilience to scale up programs,” said Michel Kazatchkine, former French ambassador on AIDS and former executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, offering a note of warning to the audience.

“I don’t doubt we have the tools [to reach the 2015 targets set in the Millennium Development Goals], but we need the resources now to consolidate and scale up our response.” Kazatchkine said not all countries are yet under pressure to contribute or step up their contributions because the slowing down of international resources in some countries has been compensated by an increase in domestic AIDS spending. And although the Global Fund and PEPFAR have clearly indicated that their programming is not at risk despite current economic challenges, he reminded the audience that there is a lack phase between decreases in assistance and impact on programs.

UNAIDS reported in advance of IAC that more than 80 countries had increased their domestic investments of AIDS by more than 50 percent between 2006 and 2011, and domestic public spending in sub-Saharan Africa (outside of South Africa) increased by 97 percent over the last five years. Meanwhile, international AIDS funding remains flat-lined at 2008 levels.  “This is about country ownership, sustainability and a strong signal that HIV/AIDS is given a true priority,” Kazatchkine said.

The majority of the increase in domestic public funding of AIDS has taken place in BRICS countries – Brazil, Russia, India, China and South Africa. “What I would wish to see is a continuing increase in domestic public spending on AIDS and the additional resources we need from international funding to combat AIDS.”

He then listed five critical comments about successfully providing universal access to HIV treatment and care:

  • While efficiency gains are important, they are not enough. International funding is and will remain critically needed.
  • International funding is at high risk in the current economic crisis.
  • Political leadership is faltering, and bipartisan support is key.
  • It is more pressing than ever that we make the case for funding AIDS and health because it is the right thing to do.
  • More multilateralism is needed, not less.

While he admitted that the last point would be harder to grasp outside of the Euro Zone, as in the U.S. where more than 80 percent of international aid is delivered bilaterally, Kazatchkine said multilateralism is the right way to deliver on global solidarity – working together to commit and fight for the resources to end the epidemic.

Human rights lawyer Dr. Gorik Ooms hit the audience with a dose of reality, stating that everyone knows the 2015 MDGs will not be achieved, and in fact negotiations are already under way on what to focus on beyond 2015. His educated guess is that there will be only one health goal in the next development goals – something like universal health coverage (UHC).

“We have to prepare for a world in which AIDS will be considered as any other disease,” Ooms said, adding that the right to health does not support the prioritization of a single disease over others. “We have to understand how truly exceptional this global AIDS response has been – and hope that this exceptionalism translates to other health issues.”

Ooms said the idea of real hope and real UHC for all will “work” for the fight against AIDS, but if and only if AIDS fighters work for UHC and make it their own.

“That can be and should be and will be the legacy of the fight against AIDS.”

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