Global AIDS and Health Fund: what is it?

Julian Meldrum
Published: 19 June 2001

From 25 to 27 June, the United Nations General Assembly will be holding a Special Session on AIDS in New York (known as UNGASS). The world’s media will focus on the response of governments, corporations and communities. Can the scale of the global response match the scale of the AIDS disaster, especially that currently facing Africa?

A ‘Global AIDS Trust Fund’ has been promoted by economists led by Harvard University’s Professor Jeffrey Sachs as a means of addressing this issue, a call which has been taken up by the leadership of the United Nations. A ‘Global AIDS and Health Fund’ covering both prevention and treatment for HIV/AIDS, malaria and tuberculosis is now under active discussion among the UN, the ‘G8’ countries, and other interested parties. At current levels of donor commitment it will not provide widespread access to antiviral treatment, though it could lay the foundations for future treatment programmes. Its progress will depend on creating a funding system that wins broad support from donors, recipients and suppliers of goods and services.

Where have these proposals come from - and what are their chances of success?

Sachs and colleagues began by estimating the resources needed, to apply current best practice in HIV prevention across Africa. Some countries have managed far better than others in controlling HIV. ‘Success’ comes with higher levels of political commitment, more investment in prevention, research, education and care. Uganda and Senegal, in particular, have received higher levels of overseas aid targeted at HIV-related health needs than comparable countries which have fared worse. Such studies yield international targets in the region of $1 billion to $2 billion US dollars, in addition to increased spending by African governments themselves.

Writing in the May 2001 issue of Nature Medicine, Sachs – who chairs WHO’s Commission on Macroeconomics and Health – extends this call to treatment for HIV, beginning with a fund of $4 billion which he thinks will need to rise to $10 billion annually, including the cost of HIV prevention.

Sachs calls for additional funding to revive programmes to control malaria, tuberculosis, and childhood diseases, which could cost another $10 billion. As Sachs puts it, ‘Global donor support of $10-20 billion per year, much less than 0.1% of the combined $25 trillion gross national product (GNP) of the rich nations, would save millions of lives each year and would enable Africa to escape from a downward spiral of disease and economic collapse.’

UN Secretary General Kofi Annan has called for a fund rising to $7 to $10 billion a year, to cover TB and malaria as well as HIV/AIDS. This funding would aim to repair and extend damaged public healthcare systems across Africa and in ‘least developed countries’ in Asia, Latin America and the Caribbean. It is notably less than Sachs is calling for and, because it is not limited to Africa, would need to meet wider demands.

Despite many unanswered questions about the management of this Fund, on which the UN has been consulting a wide range of interested governments and other agencies, it has met with some positive responses from donors. So far, the USA has pledged $200 million for the first year, Britain £75 million, and France 150 million euros over three years, which might suggest an initial budget closer to $1 billion than $20 billion, when other countries and possibly the European Union have made similar contributions.

What will the fund pay for?

The model for how the fund would be managed is likely to be the Global Children’s Vaccine Fund, now part of the Global Alliance on Vaccines and Immunisation (GAVI). That fund was set up with US $750 million from the Gates Foundation, and it is certainly hoped by the UN that private donors will contribute to the new fund. Indeed, the Gates Foundation has already pledged $100 million and the first corporate donation, of $1 million from a Credit Suisse company (Wintherthur Insurance), has also been announced.

According to Jeffrey O’Malley, who represented the International HIV/AIDS Alliance at one round of consultation, held in Geneva from 3 to 5 June, media reports that the Fund would be limited to HIV prevention are incorrect. The allocation of money between HIV, TB and malaria, and between specific programmes and strengthening of healthcare systems, has not been decided. There is a growing consensus that prevention programmes, especially those which depend on HIV testing, cannot be sustained without expanding access to treatment at the same time.

The fact that key policy makers associated with major donors have expressed a strong preference for the Fund to focus on the prevention of HIV (including condom supplies and antiretrovirals to prevent mother to child transmission), plus malaria prevention and tuberculosis treatment, should limit any expectations that the Fund will deliver large-scale treatment for HIV in the short term. On the other hand, where effective tuberculosis treatment programmes are in place, they can probably provide the best and most appropriate framework for delivering antiretroviral drugs in most countries.

Who will run it?

The Global AIDS and Health Fund (whose title may still change) will be set up as a public-private partnership, governed by a board representing different agencies and sectors. These will include key UN agencies, donor governments, recipient governments, and non-governmental organisations. Whether drug companies should be represented has been under discussion; many take the view that conflicts of interest would be too great to allow this.

The next step is likely to be the formation of an interim group of representatives of these constituencies, to be replaced once the ‘constituencies’ are better defined through some process of election.

Many other questions remain to be answered. There seems to be opposition to creating a new agency to hold the fund and a preference for managing it through an ‘alliance’ of existing agencies. Where the money will ‘sit’ is still unclear.

Who will benefit from the proposals?

It is also unclear, which countries will be able to draw on the fund. The 78 countries eligible for World Bank International Development Association (IDA) funding will almost certainly be able to do so. However, the countries which could most rapidly extend access to treatment and care are likely to be those which are wealthier and have better public health services. For example, the IDA list excludes South Africa, Namibia, Botswana and Swaziland (although it does include most African countries).

What else needs to happen for the Fund to be useful and sustainable?

The biggest questions go beyond the Fund itself.

Firstly, for many countries, cancellation of unsustainable international debts is likely to do more to enable their governments to respond to HIV and AIDS than any amount which is likely to be received from the Fund.

Secondly, the Fund will only help if it represents money given in addition to that which is already being spent to address needs related to poverty and health inequality. If money is diverted from other international development budgets, it could do more harm than good.

Thirdly, its success will depend on progress on other issues which are central to growing global inequality. These include the quality of government; investment in education – especially for girls; respect for human rights and conflict resolution; and the unequal terms of international trade.

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Links and further reading

G8 Genoa Summit – the Okinawa communique, in the protocols section, includes previous commitments on HIV/AIDS, tuberculosis and malaria.

International HIV/AIDS Alliance Policy Statement on the need for additional international funding.

Sachs, J ‘A new global commitment to disease control in Africa’. Nature Medicine, vol 7 no 5 pp 521-523, May 2001

Tackling the Diseases of Poverty – UK government report, endorsed by Prime Minister Tony Blair, which sets out an agenda for the G8 on HIV/AIDS, tuberculosis, malaria.

UK Department for International Development – has issued a departmental strategy paper this year on HIV and AIDS.

UNAIDS – includes papers related to the UNGASS process.

The World Bank’s IDA list of least developed countries

Community Consensus Statement on Access to HIV Treatment and its Use for Prevention

Together, we can make it happen

We can end HIV soon if people have equal access to HIV drugs as treatment and as PrEP, and have free choice over whether to take them.

Launched today, the Community Consensus Statement is a basic set of principles aimed at making sure that happens.

The Community Consensus Statement is a joint initiative of AVAC, EATG, MSMGF, GNP+, HIV i-Base, the International HIV/AIDS Alliance, ITPC and NAM/aidsmap

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