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HEALTH: Not Enough AIDS Funds and Not Always Well Spent

Emilio Godoy

MEXICO CITY, Aug 5 2008 (IPS) - Developing countries are in need of large sums of money to fight diseases like HIV/AIDS, but international aid will not entirely cover their needs.

An example of the financial demand is the application by Latin American and Caribbean countries for 600 million dollars, submitted to the Global Fund to Fight AIDS, Tuberculosis and Malaria during its round eight call for proposals, which ended Jul. 1. This is three times the amount requested in 2007, the Global Fund said in a press release.

“This is a historic amount, when compared with recent applications,” Michel Kazatchkine, the executive director of the Global Fund, told IPS at the 17th International AIDS Conference which opened Sunday in the Mexican capital.

Between 2002 (when the Global Fund was created) and 2008, Latin American and Caribbean countries have applied for six billion dollars, and have received 865 million dollars in grants.

In all, 97 countries asked for a total of 6.4 billion dollars in the eighth round, to combat the three diseases. Nearly half the funds will go to fight HIV/AIDS, 30 percent for malaria and the rest for tuberculosis. African countries have applied for the most funding, approximately 4.2 billion dollars.

The level of applications “is good news for the communities, because the funds are sorely needed,” Gracia Ross, a non-governmental Latin American delegate on the Global Fund Committee, told IPS.

The Global Fund was created at the suggestion of the Group of Eight (G8) most powerful countries and a group of African nations. To date it has approved grants worth 11.4 billion dollars to over 550 programmes in 136 countries to support aggressive interventions against AIDS, TB and malaria.

A partnership between donor governments, civil society organisations, the private sector, philanthropic organisations and affected communities, the Global Fund currently provides one-quarter of all international financing for AIDS worldwide, as well as two-thirds for TB and three-quarters for malaria. The World Bank acts as its trustee.

But aid from the Global Fund will not be enough to finance developing countries’ healthcare needs or research efforts to curb the AIDS epidemic.

Therefore these countries and several non-governmental organisations (NGOs) have asked industrialised countries for more health funding, especially for combating diseases like HIV/AIDS, and this is one of the most hotly debated issues at this week’s conference.

The resources can help to improve the quality of medical services. That’s why we need cooperation to expand medical care, said Peeramon Ningsanond, head of the Thai Health Ministry’s AIDS office, during a session on accountability, transparency and aid resources.

The Joint United Nations Programme on HIV/AIDS (UNAIDS) estimated that developing nations will need 42.2 billion dollars in funding to reach the 2010 goal of universal access of HIV/AIDS sufferers to treatment with life-extending antiretroviral drugs.

The social movement Tenemos Sida (We Have AIDS), a coalition of Spanish and international NGOs, calculated what would be a “fair share” for each country to contribute towards this goal, according to the size of its economy, and presented its results at the AIDS conference.

From this point of view, only Ireland, the Netherlands, Sweden and the United Kingdom contributed their “fair share,” with 1.4 billion dollars. According to Tenemos Sida’s figures, in 2010 these four countries ought to provide between 2.3 billion and 3.6 billion dollars to fight the epidemic.

Nevertheless, 10 billion dollars in international aid went to fight AIDS in 2007. But the way the funds are used is the subject of intense debate. The latest issue of the international journal Science says that a large proportion of the donations were concentrated in a few countries, which were not necessarily those most in need.

And in spite of the massive flow of funds, the number of people needing antirretroviral therapy continues to rise, which reflects the success of the treatment but also the failure of prevention efforts. All this raises disturbing questions about whether the resources will be able to satisfy future demand, Science said.

Lesotho’s Health Minister, Mphu Ramatlapeng, said at a meeting on the international AIDS financial architecture that it is difficult to convince donors to adjust to the arrangements made by different governments, because there is a risk of losing those donors.

According to UNAIDS, in 2007 there were 33 million HIV-positive people throughout the world. Of these, 2.7 million live in Latin America and the Caribbean. Brazil and Mexico are the countries with the highest prevalence, with 800,000 and 200,000 people living with the virus, respectively.

A study carried out in Rwanda on models of financing the care of patients with AIDS, presented on Tuesday, underlined the need to take nationally designed health plans into account.

The existing cost models cannot always modify the context of the country, organisations and services, Dr. Angelique Rwiyereka, a researcher at Brandeis University in the U.S. state of Massachussets, said Tuesday.

In Rwanda, her home country, which has a 23 percent AIDS rate, the cost gap ranged from 1.08 billion dollars (120 dollars per patient), according to the model used by UNAIDS, to 199 million dollars (22 dollars per patient), under the national plan.

Most of the difference lies in the fact that the first budget is more comprehensive, because it includes services to orphans and high-risk children, as well as people living with HIV.

One of the touchy issues is the sustainability of funding. “That’s why we say spending must be increased, because the Fund will not be here forever,” said Kazatchkine.

The example is Latin America, “the region that has had the best response,” he added. The Global Fund has kept a tight hold on its aid in the region. To qualify for funds, each country must establish a nationwide coordinating mechanism, with representation of all vulnerable population groups, and an organisation that administers the funds, which is virtually always an NGO.

However, the Global Fund has also set strict restrictions on middle-income countries like Mexico. This country, which has not yet submitted a project to the Fund, can only use the funding to help population groups with HIV rates of at least five percent, which only means men who have sex with men and intravenous drug users.

“Every country should be eligible, and eligibility must depend on epidemiology,” said Kazatchkine, a French doctor who in 1983 diagnosed the first couple in his country with HIV/AIDS.

The Global Fund is not likely to meet all of the need for funding in Latin America and the Caribbean. “We believe (the Fund) will be wise enough to listen to the voice of NGOs and poor countries,” said Ross.

There are 30 delegates of NGOs on the board of directors of the Fund, which announced the start of its Round nine call for proposals in October.

Some 25,000 representatives of international bodies, civil society organisations and governments of more than 150 countries are meeting through Friday at the conference in Mexico City to discuss the AIDS epidemic.