During its meeting in November 2011, the Global Fund to Fight AIDS, Tuberculosis and Malaria set the stage for the next five years, 2012-2016.
Meeting in Ghana, the Global Fund board discussed how the organization should "invest for impact," and created several objectives to ensure continued success in fighting HIV/AIDS, tuberculosis and malaria. These objectives will support funding decisions that will impact projects for HIV/AIDS prevention and treatment to meet a target of 7.3 million people alive on anti-retroviral drugs by 2016.
The Global Fund celebrates its tenth anniversary in 2012, having been established in 2002 as a result of growing concern over global health issues. Andy Seale, senior advisor for gender and sexual diversity at the Global Fund, explained that there were three major factors that contributed to the organization's founding. First, a group of African presidents met in 2000 to discuss malaria and decided that a discussion on the growing HIV/AIDS crisis was imperative. Second, the G8 countries were involved in similar conversations during their meeting, and an innovative public-private partnership approach to funding for world health initiatives was beginning to take shape. Third, organizations and individuals living with and affected by HIV/AIDS were speaking out, demanding better solutions to the crisis.
In 2001, the UN General Assembly held a special session. "I think it was the first time there had been a special session of the General Assembly that had been dedicated to a particular disease," said Seale.
The special session accomplished two key objectives, creating a blueprint for activity and developing a strategy for funding that would include a partnership between all stakeholders, government donors, private sector organizations, community groups, people living with the disease and implementing countries, with a particular focus on African governments.
The Global Fund was created as an international fundraising organization, which would raise and disburse money for locally driven projects to combat HIV/AIDS, tuberculosis and malaria around the world.
From the beginning, U.S. political leaders committed strongly to ensuring the organizations success. Legislation was passed to allow the United States to contribute to the Global Fund and former President George Bush gave the first pledge. It was also established that for every $1 contributed by the country, other countries had to contribute $2, which would ensure that no more than 33 percent of the organization's overall earnings would come from the United States, and served as a challenge to other countries to dedicate themselves and create a truly global organization. Today, the United States remains the largest contributor.
According to Natasha Bilimoria, president of Friends of the Global Fight Against AIDS, Tuberculosis and Malaria, the United States steadily increased its contributions from $300 million in 2002 to $1.05 billion in 2010.
Today, 90-95 percent of the contributions come from donors like the United States, France, Germany, the United Kingdom, Australia and other developed countries.
The commitment of donor countries, private sector organizations, community groups, people living with HIV/AIDS and implementing countries has been substantial over the past 10 years.
"When you look at what we've been able to achieve since 2002, it's been fairly significant," said Seale. "We estimate that around 2.5 million of the 5.3 million people who were receiving anti-retroviral treatments in 2009 were supported by the Global Fund, which is something that we pretty much started from a baseline of zero in the developing world in 2002."
Additionally, the Global Fund website reports, "By the end of 2010 more than 5 million people in low- and middle-income countries had access to antiretroviral therapy, of whom 3 million were receiving it through Global Fund-financed programs. With the substantial increase in resources available to fight the disease, AIDS mortality has decreased in many high-burden countries."
"We've had a number of targets that we've described in different strategies," Seale explained. "For example, targets that we set ourselves for 2010 around key services were very robust for HIV. We reached 100 percent of our targets for people receiving anti-retroviral therapy. We exceeded the targets we had set ourselves for HIV testing and counseling, and also around support to orphans and other vulnerable children. And, we did very well, around 94 percent, of our targets when it came to some of the HIV prevention initiatives like prevention from mother to child transmission and condom distribution."
Despite great strides, the Global Fund is preparing for an unsure future in terms of funding. For the first time, the organization experienced stagnation in U.S. contributions, with funding remaining at $1.05 billion in 2011. Seale said it's been more difficult in recent years to raise the funds necessary to continue efforts at the same rates that were established from 2006 through 2009.
Seale warns against reading too much into recent data provided by UNAIDS, which was released in November and touts strong gains in treatment access and prevention efforts.
"One of the things we are dealing with at the moment, are figures from 2010. It is always difficult for us to have a real time understanding of what the implications are. So the UNAIDS data will be from last year, and there is probably some time lag as well as from the years of key investment and what will be happening in the immediate, next two to three years.
"I think that we should be very concerned about the short or medium term. It's true that we are still probably seeing, in terms of the results, an impact from investment that was at strong levels in 2007-2008. So in 2010 we will still be benefiting from those levels of investment. But my suspicion is when we get to 2012-2013 the situation may not be as robust as we are seeing this year.
"Its not just the United States, it's all of our donors. We are concerned that the Global Fund does continue to be fully replenished and is able to continue the previous rates."
Seale says round 10 funding was the first time organization leaders really began to become aware of the impact of the global economic crisis and the likelihood of constrained resources. The potential impact required the organization to think differently about its funding formula.
"We've always had a prioritization formula or framework set in place that will prioritize the lowest income countries that have the highest disease burden, but what we recognized in the run up to round 10 was that if we didn't have an additional step in place we could end up de facto prioritizing programs that were just destined for Africa. So programs that we need for Asia or Eastern Europe and Latin America for example might not be funded because of things like the income status of the countries."
As a result, the organization created a smaller, reserve budget for countries with concentrated epidemics, such as drug users, sex workers and men who sleep with men, to ensure access to Global Fund financing.
Potential challenges like those faced in round 10 were no doubt part of the November discussion as the 2012-2016 strategy was developed.
Seale said that another key issue has been a growing concern over human rights in implementing countries. Though the Global Fund has always been a human rights focused organization, it was never implicitly stated. Beginning in 2012, human rights, in relation to all three-focus areas, is listed in the five-year strategic plan.
As a result, the Global Fund will increase investment support to programs that specifically address human-rights issues.
"What we are trying to do is really send a message to countries that we really need to see programs suggested to us by countries that properly address the entirety of the epidemics in those countries," Seale said. "For example, most countries will have an element of their HIV epidemic concentrated amongst men who have sex with men, regardless of where you are in the world it's likely that part of your epidemic will be among that community, and it is really important that countries properly address that part of the epidemic as well as other parts of the epidemic."
During its 10-year history, the organization has made tremendous strides against a disease that was decimating a nation and devastating lives around the world. At this pivotal moment when a reduction in funding could easily rollback significant advances, the Global Fund remains focused on meeting its goal of 7.3 million people alive on anti-retroviral drugs by 2016.
