An evening with Mark Dybul: Great challenges and great opportunities

By Clare Morrison

Clare Morrison is Support Officer: Influence at the Alliance.

On the 31st May, Mark Dybul will step down as Executive Director of the Global Fund to Fight AIDS, TB and Malaria. During his five-year tenure, the organisation has continued to deliver impressive results, with 146 million new infections averted across the three diseases.

Mark Dybul

Mark Dybul addressing the Alliance's annual Donor's Consultation Meeting in Brighton

However, such successes were never a given. Mark Dybul’s appointment came at a turbulent time, with allegations of financial mismanagement prompting several major donors to suspend their contributions to the fund. However, under his leadership, the organisation has undergone something of a renaissance; with two successful Replenishments, a significant expansion in human rights and gender-based programming and a 41% increase in domestic financing for health.

Finding hope in times of adversity is something Mark wanted to reflect upon during his keynote speech at the Alliance's annual Donors’ Consultation Meeting in Brighton last week.

"We are living in unprecedented times"

He opened his speech by referring to the rapidly changing political and socio-economic environment that we currently find ourselves in - drawing on recent election results, the rapid growth in wealth and inequity, changes in migratory patterns and unprecedented demographic shifts.

Yet, despite this period of flux, he remained cautiously optimistic, arguing that political uncertainty often creates the opportunity for new ideas, technologies and innovations.

Capitalising on past achievements

One of the best examples of this is the global HIV response. Fifteen years ago, it was the prevailing assumption among public health specialists that antiretroviral therapy (ART) could not be replicated in Africa or any other low-income settings. However today, more than 17 million people globally are receiving HIV treatment.

So, in challenging times how do we keep building on past successes? One source of inspiration is William Foege, whose book “House on Fire”, explains how smallpox – a disease that killed and scarred millions over centuries of human history – was completely eradicated through responses implemented at the community level.

“There’s no such thing as a global epidemic, what we have is a series of ‘micro’ epidemics”

Indeed, for Mark, the answer lies not just in increasing ART coverage, but in understanding the communities that are most affected by HIV.

Instead of focusing on global or national epidemics, we must instead turn our attention to the “micro-epidemics” and find new ways of reaching the people behind the statistics.

Why are certain groups vulnerable to HIV and how can we tailor our responses to meet their individual needs? These are the questions that need to be answered.

This will require a renewed focus on the people most at risk of infection. This includes adolescent girls and young women, who in some countries are up to 14 times more likely to contract HIV than their male peers. Here, Mark took the opportunity to praise the Alliance for its leadership in this area, referencing Link Up, a project that worked with over 940,000 young people living with and most affected by HIV, empowering them to take control of their sexual and reproductive health and rights.

Finding new and innovate sources of financing for HIV

Nevertheless, this type of programming requires strong financial backing. In today’s economic climate this is a tough ask. External resources for development are in decline. Taxpayer’s decreasing support for development will likely worsen the impact on the HIV epidemic as the burden shifts to middle-income countries, where official development assistance is not available.

Mark argued that if we are to end the epidemic we must focus on new, more effective ways to raise funds. This includes pursuing more innovative finance platforms, such as blended finance, which combines development finance and philanthropic funds to leverage additional private capital, grants and loans. The benefits of financial investment must also be made clear, not just from a human rights perspective, but from an economic and security perspective too.

However, such commitments can only be achieved if donor governments and politicians step up and show moral leadership. HIV, by its very nature is a virus that lives in the shadows. It affects the most marginalised people in our communities: people who use drugs, men who have sex with men, sex workers, adolescent girls and young women. Therefore, unless we act “collectively to become better human beings” the chances of ending the epidemic remain slim.

The audacity of hope

So, whilst the challenges remain, the choice is clear. As Mark said, “we can look inward and backward, with fear and its constant companion, hate. Or we can look forward and outward”.
The global HIV response has faced challenges before, but we have almost always won.