Underfunded Global Fund punishes ambition by rejecting AIDS proposals, next opportunity for funding significantly delayed

The Global Fund to Fight AIDS, Tuberculosis and Malaria has rejected ambitious proposals to turn back the AIDS epidemic in several high-burden sub-Saharan African countries. It has also decided to significantly delay the next opportunity for countries to apply for funding until December 2011, which leaves dangerous gaps for countries whose proposals were rejected.  These decisions will hamper scale up of HIV treatment and implementation of state-of-the art strategies to prevent the spread of the virus, according to international medical humanitarian organisation Médecins Sans Frontières (MSF).  

The World Health Organization(WHO) and other experts have recognized that early initiation of treatment is key to turning back the AIDS pandemic.  For example, in a two-year study by MSF in Lesotho, patients who started treatment earlier were 68% less likely to die, 27% less likely to get new infections such as tuberculosis and 39% more likely to remain in care compared to patients who started treatment when their disease was more advanced.  

However, countries’ proposals to initiate early treatment, implement WHO guidelines and aggressively reduce transmission both between mother and child, and between adults, have been denied.

For example, Malawi’s proposal to reduce transmission may have been regarded as too ambitious.  The proposal focused heavily on tackling transmission of HIV from mother to child by providing lifelong HIV/AIDS treatment to all HIV-positive pregnant women. They had also planned to spend more to retain health workers and scale up voluntary male circumcision to help slow down the spread of HIV. Similarly, Uganda’s proposal was rejected, which had planned to dramatically increase its coverage rates of prevention of mother-to-child transmission, which currently stand at just under 50%.

Other countries are in a similar situation: Swaziland, Mozambique, Democratic Republic of Congo and Zimbabwe are among the high-burden countries that will receive no additional funds for AIDS treatment or prevention by the Global Fund in 2011.  

“These countries are among those hardest hit by the AIDS epidemic, so they must be given an opportunity to put in place programmes that will alleviate this enormous burden,” said Dr. Jennifer COHN of MSF. “It is crucial that countries ensure the money is used to fund the most sound treatment approaches and governments are accountable, but without additional funding, these countries will not be able to turn the tide on AIDS.”

MSF calls on the Global Fund board to reconsider its decision to delay the next funding round.  MSF is also calling on donors to pledge additional funds to fill the US$8.3 billion deficit which resulted from weak donor pledges at the October replenishment conference.  Donors such as Italy, the Netherlands and Sweden that have provided no support, and those that did not provide their fair share, such as Germany, need to do so urgently.   

MSF also underlined the urgency of creating innovative financing mechanisms such as a financial transaction tax for health to support the Global Fund and global health.