Financing trends and making smarter investments in the HIV response

by Ishdeep Kohli | @theaidsalliance | International HIV/AIDS Alliance - UK
Tuesday, 22 July 2014 15:53 GMT

A male sex worker and member of MSM rights organisation PEMA Kenya, credit: Nell Freeman for the Alliance

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During a high-level political session at the 20th International AIDS Conference, UNAIDS executive director Michel Sidibé has called for a new set of treatment targets by 2030.

These include that 90 percent of all people living with HIV know their status, 90 percent of all people diagnosed with HIV receive treatment and 90 percent of all people receiving HIV treatment have durable viral suppression.

Ending the epidemic

Mark Dybul, executive director of the Global Fund, said at the plenary session that scientific advances and years of implementing programmes have given the global community an historic opportunity to end the HIV pandemic.

Traveling that last mile will require smarter investments, setting more refined epidemiological targets and focusing on the most vulnerable people. He urged partners to work together to seize the moment and use all the tools available to have the greatest impact in a more intelligent way. “The goal we can and must have today is ending HIV as an epidemic and turning it into low-level endemicity,” he said.

Address people at greater risk

Twelve years ago, when the Global Fund was founded, the HIV response was centred on stopping death and as many new infections as possible, so targets in the fight against the disease were set with that reality in mind. Dybul argued that to achieve the goal of ending the HIV epidemic, it is essential to have equity and to address the people at greatest risk of becoming infected with HIV;  women and girls, sex workers, people who use drugs, men who have sex with men, transgender people, people in prison and migrants.

Epidemiological data shows HIV exists in hotspots. Bringing the epidemic under control will mean moving beyond the ‘tyranny of averages’ to target instead those specific geographic areas and marginalized populations most affected by the disease. Dybul said: “We have to look at geographies and we have to look at populations, those most at risk to ensure that we have equity. We have to bring the epidemic under control in all of those sub-geographies and sub-regions and all populations and key affected populations. Otherwise, we will continue leaving people behind and miss an historic opportunity to bring the epidemic under control.”

Current trends in AIDS financing

During a symposia session on AIDS financing further discussion on how to achieve an end to the epidemic highlighted the need for sustainability of funding in the current global economic climate. JVR Prasada Rao, UN Secretary General’s Special Envoy for AIDS in Asia Pacific is also chair of the high level panel on the ‘AIDS funding landscape in Asia and the Pacific’, a new initiative to help countries and development partners decide on future funding priorities and develop sustainable investment plans. He put the spotlight on how global funding for AIDS is falling short of estimated global need as donor countries are continually lowering their development aid, but added that a number of countries are leading the way in financing the AIDS response with domestic funds.

Rao gave examples of programmes in China, India, Myanmar and Thailand in which clearly targeted spending on prevention among high-risk populations substantially reduced new infections. Countries need to put greater investment in such programmes to prevent HIV infections among key populations who are at high risk such as sex workers, people who use drugs and men who have sex with men.

Continuing low level AIDS spending on key populations will not lead to the breakthroughs needed to trigger significant decreases in HIV infection rates. This thinking is backed up by the study ‘Spending of HIV resources in Asia and Eastern Europe: systematic review reveals the need to shift funding allocations towards priority populations’.

Rao said: “We must do more to ensure that the money we already have is being put to work in the most effective way to drive down the epidemic. Despite overwhelming evidence that spending on HIV prevention focused on populations at higher risk will drastically reduce new infections, all too often we see large amounts of AIDS funding directed to ‘soft’ programmes that are not focused in the areas where they can have the most impact.”

Ending HIV as an epidemic means smarter investments in the right places, making sure no one is left behind. Donors, governments, NGOs, communities affected by the disease, faith-based organizations, activists and community groups and the private sector must galvanize around this historic moment.

Ishdeep Kohli lives in India and is a member of the Key Correspondents network which focuses on marginalised groups affected by HIV, to report the health and human rights stories that matter to them. The network is supported by the International HIV/AIDS Alliance.