Global Fund Archives - TalkAfrique

December 1, 2011December 1, 2011

HIV Deadly Funding Crisis

JOHANNESBURG, 1 December 2011 (PlusNews) – This World AIDS Day on 1 Dec should have been a much more joyous event: the global HIV/AIDS response has turned a significant corner, with record numbers of people on antiretroviral (ARV) treatment and fewer new HIV infections. But the announcement by the Global Fund to Fight AIDS Tuberculosis (TB) and Malaria, cancelling its next funding round, has cast a shadow over any celebrations and highlighted the precarious nature of HIV/AIDS funding.

That money for HIV/AIDS efforts is not as plentiful as in previous years hardly comes as a surprise. UNAIDS notes that the global economic crisis appears to have put an end to a decade of funding increases by donors – after flattening out in 2009 for the first time, international AIDS assistance fell by 10 percent in 2010.

Nandini Oomman, director of the HIV/AIDS Monitor, which tracks AIDS spending at the Washington-based Centre for Global Development, admits that “we are in a bad situation” and faced with “less money and more [health] priorities”. Moreover, non-communicable diseases have overtaken HIV/AIDS as the leading cause of death worldwide. Global and national leaders are now confronted with a “set of tough choices”, she noted.

Zimbabwe’s Minister of Health, Dr Henry Madzorera, believes it is still too early to gauge the full impact of the global funding decline. “We do anticipate that [this] will have a negative impact on our universal access goal… that the consequences of this global economic meltdown will be catastrophic to our programmes… [and] will take us back many years,” he told IRIN/PlusNews.

The big squeeze

As the world’s largest donor to HIV/AIDS efforts, the United States contributes 54 percent of international AIDS financing, but the Centre for Global Development warns that in America’s current political and fiscal climate, this level of support for AIDS funding may have reached a “tipping point” and “will be increasingly difficult to maintain in coming years”.

Oomman pointed out that the US President’s Emergency Plan for AIDS Relief (PEPFAR) was protected by legislation until 2013, so cuts in the funding mechanism may not be as deep as feared. “The real questions [about the future of PEPFAR] will open up in two years, when the US is faced with reauthorizing PEPFAR,” she noted.

In the meantime, the US global AIDS budget has been cut for the second year running – funding for PEPFAR in 2012 will be US$90 million less than the current allocation – and support for the Global Fund has flat-lined.

The cost implications are huge, particularly for countries such as Uganda that rely heavily on PEPFAR. According to Médecins Sans Frontières (MSF), less than half of the people needing treatment in Uganda get it, and PEPFAR currently supports 75 percent of all patients receiving ARVs in the country. International donors are increasingly requesting that Uganda look for domestic funds to support its response.

Although South Africa is better resourced and funds more than 80 percent of its treatment costs, it still receives substantial amounts from foreign donors. PEPFAR’s shift from direct service provision to technical assistance has caused hospices and institutions that were providing ARVs to close down, and patients have been referred to a public health system that is overstretched and poorly equipped to deal with the growing numbers, Nokhwezi Hoboyi, district coordinator for the Treatment Action Campaign, told journalists at a press briefing.

The UK’s Department for International Development (DfID) is also cutting bilateral aid for HIV/AIDS projects in developing countries by 32 percent, from £59.9 million ($92 million) to £41 million ($64million), between now and 2015.

Bailing out of the Fund?

With many donor countries preoccupied with the economic crises on their doorsteps and slowly starting to reduce their HIV/AIDS funding, the Global Fund remains a crucial player despite its latest setback. The amount of money that the multilateral body has made available since it was created in 2001 was “absolutely unprecedented” said Dr Eric Goemaere, head of MSF South Africa’s medical unit.

On 28 November, MSF warned that many low-income countries with a high HIV/AIDS burden were relying heavily on money from the Global Fund to continue providing treatment as well as to scale up their programmes. Some countries have been unable to implement the most recent World Health Organization guidelines, which call for earlier initiation of treatment and better first-line drugs.

The Global Fund has also been hit by a crisis in confidence in recent months, after reports of grant mismanagement found by the Fund’s Office of the Inspector General and the findings of a high-level independent review panel that recommended major changes to its accountability structures.

Oomman told IRIN/PlusNews that rather than “buckling down” to fix the Global Fund model, however, donors were “bailing out” by failing to live up to their commitments. “This doesn’t absolve the Fund of the responsibility to fix itself and reform… but it was created by the donors and should be fixed by the donors,” she commented.

High-burden nations need to do more

With its future at stake, the Global Fund has been encouraging emerging markets to pick up the baton, but the reality is that financial backing from traditional donors such as America and the European countries is still vitally important. “If I were an emerging market government, would I put my money in [an organization] which Western donors are pulling out of?” Oomman asked.

Activists agree that although some countries with high HIV prevalence rates still can’t afford to put a lot of money into their AIDS response, they cannot be completely absolved.

“Sustainability depends on domestic funding. Even in this hard economic environment, countries can at least lay down the enabling instruments that will grow over time and take over from donor funds when these funds dry up,” Zimbabwe’s Madzorera acknowledged.

“African governments are not doing enough at this stage,” he said, “and it cannot be allowed to be ‘business as usual’ in the face of this global economic crisis.”

UN IRIN NEWS

May 19, 2011May 24, 2011

Report Recommends Alternatives to Top-Down 100 Percent Condom Use Programmes for Sex Workers

David Garmaise, allafrica

Although 100% condom programmes can be effective in increasing condom use in commercial sex transactions, they should be implemented in ways that do not violate the human rights of sex workers or their clients.

This is one of the recommendations in a report on human rights and the Global Fund recently released by the Canadian HIV/AIDS Legal Network and the Open Society Foundations (OSF).

These 100% condom use programmes (also called 100% CUP) are a central part of national HIV responses in a number of countries, including China, Cambodia, Vietnam, Thailand, Mongolia, Laos and Myanmar.

These programmes, which are designed to ensure that condoms are used in all commercial sex transactions, usually target sex workers in brothels or entertainment establishments. According to the report, in most cases, the strategy is to make commercial sex without condoms illegal and to enforce that illegality – which means that local authorities and the police are, inevitably, integrally involved in these programmes.

The report acknowledged that evaluations have found these programmes to be effective in reducing unsafe sex in commercial sex establishments. However, the report added, although they are meant to protect sex workers and their clients, in most cases the programmes have been designed without meaningful participation of sex workers or their NGO allies. Also, sex workers’ experiences have not frequently figured in evaluations of these programmes.

Finally, according to the report, several studies have documented abusive practices in these programmes, such as: forced registration of sex workers; mandatory STI testing and health examinations at health facilities where sex workers were mistreated; repressive policing; force-marching of sex workers to health facilities with military or police escorts; and public posting of photographs of sex workers who are accused of having had sex without condoms.

In one of these studies, the report said, sex workers reported that they were forced by brothel and nightclub owners to have sex with police in exchange for the police looking the other way when 100% CUP rules were violated.

The authors argued that there are other ways to achieve the target of 100% condom use, without having to resort to mandatory and abusive measures. The report cited the example of sex worker collectives such as those in the Sonagachi neighbourhood of Kolkata, India. The authors said that these collectives have created an environment that ensures that all workers demand condom use; and that the work of these collectives has resulted in both (a) effective HIV prevention and (b) empowering sex workers to stand up to police brutality and stigma in the community.

However, the report said, it may be that these alternative strategies are not well known to CCMs. The use of 100% CUP continues to be supported by CCMs; for example, in a Round 9 Indonesia proposal, the programme included promulgating and enforcing local regulations so that regular condom use would become the norm where sex is sold.

The Legal Network and the OSF recommended that the Global Fund develop criteria that would allow it to identify and reject proposals that include prevention programmes for sex workers that exhibit a lack of human rights protections for the workers and their clients. The report said that CCMs or other applicants that propose 100 percent condom programmes should be required to provide detailed information about the implementation of these programmes, including, for example:

the nature and degree of participation of organisations that are legitimate representatives of sex workers in the design, implementation and evaluation of these programmes;
measures taken to protect sex workers against abuse by clients, police and managers of brothels or entertainment venues; and
measures taken to consider less top-down alternatives to 100% CUP.

Finally, the authors recommended that the Technical Review Panel (TRP) be fully briefed on 100% CUP and alternatives to it; and that the Global Fund invest in capacity-building for CCMs in this area, including providing them with information on best practices

March 10, 2011March 13, 2011

Cuts That Kill: The Senate Must Restore Global Health Funding

Joanne Carter

Executive director of RESULTS/RESULTS Educational Fund (REF)

Last week Congress approved a two-week extension of federal funding to avoid a looming government shutdown. The vote postpones — but does not resolve — potentially devastating cuts to global health programs. The House-proposed bill for the balance of 2011 proposes deep cuts to some of the most effective investments the US makes globally, including a drastic 40 percent reduction for the Global Fund to Fight AIDS, Tuberculosis and Malaria.

In a recent interview Michael Gerson, a former speechwriter and advisor to President George W. Bush, called the cuts “irrelevant and destructive.” He’s right on both counts, and there’s still time for Congress to reverse course.

The cuts are irrelevant to the deficit problem that members of Congress are ostensibly trying to solve. Our entire foreign aid portfolio amounts to little more than a rounding error in the federal budget. Foreign aid focused on health, education, economic opportunity, and other anti-poverty programs account for less than 1 percent of federal spending. Even if Americans believed that erasing these programs was a good idea — and they don’t, as public opinion polls consistently reveal — it wouldn’t put a dent in the deficit.

These cuts are destructive because they would be measured in human lives.

With the U.S. as a leading donor, the Global Fund has helped save more than six million lives, and in just a decade has fundamentally altered our ability to fight AIDS, TB, and malaria, among the biggest killers on the planet. If the House proposal to slash $450 million from the Global Fund were adopted it would mean six million treatments for malaria would not be administered. More than 400,000 people won’t be provided with antiretroviral medication to treat AIDS, and nearly 60,000 women won’t receive the drugs they need to prevent transmission of HIV to their newborn children. More than 370,000 people won’t be tested and treated for tuberculosis, the world’s leading curable infectious killer of adults.

This budget crunch comes just as new tools are available to transform the fight against infectious diseases. A new way to diagnosis TB using a machine called Xpert is one such breakthrough. The current method of identifying TB bacteria under a microscope was developed nearly 130 years ago and is still used throughout the developing world. This method often fails to detect TB in people living with HIV/AIDS and in children, cannot detect drug resistance, and is frustratingly slow. Patients must take time off from work and family to return to a clinic and submit multiple specimens over several days — often an impossible demand in very poor communities. Although TB is curable, correctly and rapidly diagnosing the disease has been a major stumbling block.

Xpert has the potential to change that. It’s fast, accurate and easy to use. About the size of an espresso machine, it relies on DNA technology to diagnose TB, detects drug-resistant strains of the disease, and returns the results in about 90 minutes. That may not grab headlines, but in the world of TB control it’s nothing short of revolutionary.

Other breakthroughs abound. The promising trial results for a microbicide gel to prevent HIV transmission electrified the HIV/AIDS community in search of new prevention methods. Vaccines to help prevent pneumonia and diarrhea — the two leading killers of young children — are newly available in poor countries through the GAVI Alliance, an international partnership to expand access to childhood immunizations.

The question for Congress is whether global health policy and funding will keep up with global health evidence and opportunity.

The innovations in global health now at our fingertips are not just new drugs, vaccines, and diagnostics, but also the means of financing and delivering them. For example, The Global Fund to Fight AIDS, Tuberculosis and Malaria has led the way in changing the business model for how aid is delivered. Last week the conservative-led UK government released an exhaustive multilateral aid review of 43 development institutions which rated the Global Fund as one of nine organizations with an “excellent track record” for delivering results. Global Fund proposals are developed by the countries who implement them, they are evaluated by an independent review panel, and continued funding is awarded according to performance. Project documents — everything from glowing reports to unforgiving audits — are made publicly available on the Fund’s website.

That may sound like common sense, but it’s not necessarily common practice among global health and development aid donors.

As a board member of the Global Fund, I see the Fund’s challenges up close, and I also see its ground-breaking model, its impact and the even greater potential it represents. The proven success of the Global Fund allows us to think about seizing the next set of opportunities presented by modern medicine and break the backs of the world’s greatest epidemics.

Congress faces unenviably tough budget decisions this year, but funding for these programs is not a close call. The Senate should reverse the House’s proposed cuts to global health for 2011, and restore this sliver of the federal budget that delivers unparalleled results. To do otherwise would be irrelevant and destructive.

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