Officials Discuss Meeting Global Fund Target Of US$13B

DURBAN, South Africa – As the fund to help the world’s most suffering prepares for a conference hosted by Prime Minister Justin Trudeau and the government of Canada in September to raise US$13 billion for its 2017-2019 period, the prospect of failing to meet the target is unsettling for the civil society and the health community.

The Global Fund to Fight AIDS, Tuberculosis and Malaria’s potential as health aid is seen as boon to fight diseases. Its reach to the poor, distressed governments, shunned members of society and a known fact that it’s available to save the world is considered laudable.

From its “war chest” founded in 2002, more than $33 billion in grants to 140 countries have translated into activities such as providing antiretroviral treatment for 8.6 million people living with HIV/AIDS, insecticide-treated bed nets to protect 600 million families from malaria, and detection services for 15 million cases of TB, according to an evaluation by the Global Fund.

Globally, governments and grassroots organisations have accessed the Global Fund to advance treatment for AIDS, malaria and TB in different ways.

For instance, the Botswana government was successfully challenged in court on its policy of refusing HIV treatment to non-citizen prisoners in 2014 by two organisations that indirectly receive support from the Global Fund.

The Botswana Network on Ethics, Law and HIV/AIDS (BONELA), leading work on removing legal and human rights barriers to access in Botswana, and the Southern Africa Litigation Centre (SALC), which focuses on eradicating barriers to accessing treatment and prevention services for HIV in Africa, teamed up for the case.

Some 87 percent of people who know their HIV status in Botswana took antiretrovirals. Citizen prisoners in the country were entitled to free HIV treatment, but non-citizen foreign prisoners who made up more than 14 percent of Botswana’s prison population were not. Two foreign prisoners and with the support of SALC and BONELA took the case to court.

The High Court in Gaborone, Botswana’s capital, ruled on 22 August 2014 that denying treatment to foreign prisoners living with HIV violated their constitutional rights. On 26 August 2015, the Botswana Court of Appeal dismissed an appeal against that decision.

UNAIDS official Sheila Dinotshe Tlou told the media at the International AIDS conference in Durban that when she was the health minister of Botswana, her team gathered evidence and found prisoners came uninfected but left infected. She called for antiretroviral treatment for prisoners. It took a while, and when it happened, the treatment excluded foreign prisoners. So she mobilised for their inclusion.

“Ending AIDS is within our reach but key populations should be at the centre,” said Tlou, the director of the UNAIDS regional support team for Eastern and Southern Africa.

She said funding is needed to fight an ‘epidemic’ of bad laws in Africa that left key populations vulnerable. Tlou is concerned that when selecting key populations to benefit, some countries choose “nicer” populations, girls.

“When the proposals are made it should be clear who the key population is. We need strategic information to show the reach,” Tlou said.

She said, another research done with the World Bank in the region revealed that 18 countries had prioritized key populations in their national prevention programmes, but they were not doing anything. “It would appear they are just doing it to get Global Funds,” she said.

The fund identifies women and girls, men who have sex with men (MSM), people who inject drugs (PWID), transgender people, sex workers, prisoners, refugees and migrants, people living with HIV, adolescents and young people, orphans and vulnerable children and populations of humanitarian concern, as key populations.

Does The Fund Matter?

Judy Chang, board member, International Network of People Who Use Drugs, said the Global Fund is the single largest donor for governments and its approach to put human rights at the centre of it response makes it appealing to community organisations.

Chang cited for instance the Philippines, where the president encouraged ‘druggies’ to be killed, and when they go to seek treatment they are arrested.

She said the Global Fund enabled organisations to be part of the national dialogue, and if the fund is not fully funded such gains will be lost.

“We have biomedical tools we have to invest into community wisdom to make sure these tools are fully used,” she said.

George Ayala, ‎executive director at Global Forum on MSM and HIV in United States, shared these sentiments, saying the fund was essential in helping countries shoulder the disease burden.  He said institutions have been helped to reliably collect data among key populations.

“Because we are stigmatised governments are unwilling to support organisations in HIV community based organisations are important for key populations as they often create the only safe spaces for men who have sex with other men,” Ayala said.

Consequences of Underfunding

Backing calls for more funding, two reports on consequences of underfunding the response to diseases were launched at the Durban AIDS conference by the Global Fund Advocates Network, a partnership of more than 440 members from 76 countries.

The first report, Key Populations and the Global Fund: Delivering Key Results, focuses on groups in society often excluded for support in AIDS fight.

The second report, Global Fund Replenishment 2016: The Cost of Inaction, demonstrates that inadequate investment in the Global Fund will threaten millions of lives and result in billions of dollars in additional costs.

The report says 21 million preventable AIDS deaths and 28 million preventable new HIV infections will occur in absence if funds. Up to 45 million new TB infections and an additional 29 million people needing treatment will rise. The potential to avert 3 million malaria cases and save 10 million lives will be jeopardised.

UNAIDS Executive Director Michel Sidibé told the AIDS conference that the world is not currently heading toward an end to AIDS and tuberculosis by 2030 and he is anxious about the future of the AIDS response.

“I’m scared because I am seeing for the first time a decline in the financing from donor countries,” Sidibe said. “I cannot be dishonest with you, I need to say – we will have a resistance, we will lose our investment, we will have to pay more later.… If we stop now, we will certainly regret [it] because we will see a resurgence in this epidemic.”

It is now up to world leaders, he said, especially the heads of state of the G7 countries, to heed the call and to invest more political will and money in the global AIDS response.

“It is a disgrace that we struggle to find the less than $30 billion per year required by the Global Fund, while hundreds of billions are annually spent on wars,” he said.

 

Image Credits: Munyaradzi Makoni