Funding the end of AIDS

By Arben Fetai, Leila Zadeh

Leila Zadeh is the Alliance's Senior Advisor: Policy and Government Affairs, and Arben Fetai is a Senior EU Policy Advisor of the Stop AIDS Alliance (a joint initiative by STOP AIDS NOW! and the Alliance)

Donor governments, implementing countries, private sector and civil society partners from around the world recently pledged $12.9 billion for the 5th Voluntary Replenishment of the Global Fund to Fight AIDS, Tuberculosis and Malaria. This is a step in the right direction, but this investment is only the minimum of what is needed. The Global Fund’s Investment Case stated that $13 billion is just 80% of the full need to achieve the 2030 global targets for the three diseases.

It is estimated that the combined domestic and external funding need for HIV, TB and malaria is $97 billion for the 2017-2019 period in countries where the Global Fund invests. $41 billion of this is expected to come from domestic resources in partner countries. While domestic financing for health has been steadily increasing over the past few years, it’s still not enough to fill the gap. As an illustration, only four out of 54 African Union member states have achieved the 2011 Abuja commitment of allocating 15% of government expenditure to health.

Keya, Link Up Bangladesh

Keya, a sex worker, with her daughter Sumaiya in her house at Doulatdia brothel, Bangladesh. © Syed Latif Hossain for the Alliance

To reach the end of AIDS, donors need to support partners in mobilising additional investment but they also need to step up to the mark themselves if we are to reach the targets the global community has set. This isn’t about endlessly asking for more and more money. If we reach the global 2020 target of mobilising $26 billion per year for the AIDS response in low- and middle-income countries, we will be achieving a 15-fold return on investment and saving money in the long term by averting 21 million AIDS-related deaths and 28 million new HIV infections.

To reach the end of AIDS, donors need to support partners in mobilising additional investment, but they also need to step up to the mark themselves 

This money needs to be invested wisely to achieve the greatest impact. Investment in community mobilisation needs to be increased to 3% of total resources. Investment in advocacy, human rights, stigma reduction, law reform and policy change needs to be increased to 6% of total resources. And investment in prevention should be increased to 25%. Money should be targeted to the most affected and key populations, including men who have sex with men (MSM), transgender people, people who use drugs, sex workers and adolescents. A mix of funding to multilateral institutions such as the Global Fund, UNAIDS and UNITAID, and bilateral funding for specific programmes will help to make sure these targets and populations are reached.

For greatest effect, financial contributions should be accompanied by political dialogue. If donors want to see their money go as far as it can, it is imperative that they prioritise engagement in UN High Level Meetings, international and regional AIDS conferences and in one-to-one diplomacy with other governments.

For example, this year’s UN High Level Meeting on AIDS saw some important steps forward but it also raised concerns after the of exclusion of LGBT voices and outright attempts to alter the consensus around key population advocacy.

‘Progressive’ donors who understand the importance of such community-led responses need to match their money with strong advocacy.