Nature Medicine | Spoonful of Medicine

UNAIDS-backed reports sing the same tune but stay silent on funding crunch

World AIDS Day pic.JPG

Today is World AIDS Day, and in the run-up to the date this year, UN agencies published two reports on the state of the HIV epidemic. For the most part, the good news from these reports has captured the headlines: Topping the list of heartening statistics, 47% of people in low and middle-income countries now have access to anti-retroviral treatment (ART), up 9% from the number covered in 2009.

But a few cracks lie beneath the positive numbers. In the past week, The Economist chided the UN for publishing the two reports, one on 21 November from the Joint United Nations Programme on HIV/AIDS (UNAIDS) and another on 30 November in partnership with the World Health Organization (WHO), and UNICEF, when these UNAIDS-backed agencies could have just as well consolidated the information in a single analysis with a unified message. Conspicuously missing from the documents is the lack of a cohesive vision for meeting funding needs in a tough global economy, and that is disconcerting.

The economic reality hit home for UNAIDS when their largest funding partner, the Global Fund to fight AIDS, TB, and Malaria, canceled its next fundraiser because it had failed to collect the $13 billion it needs to fund its programs. Meanwhile, the President’s Emergency Plan for AIDS Relief (PEPFAR) has also decreased its treatment funding for antiretrovirals by $170 million since 2008

The international funding community “is kicking out the last leg of the stool,” says Sharonann Lynch, a New York-based HIV policy advisor for Doctors Without Borders (MSF). “There is this good news from the UN, but the whole thing is going to collapse without funding.”

Both UNAIDS reports call for increased funding of $22 billion to $24 billion by 2015, an enormous leap from current funding levels of just $15 billion. The 21 November report details how UNAIDS will spend the funds it gets most effectively over the coming years, drawing heavily on a June analysis in The Lancet. By locally tailoring services, targeting high-risk populations, and harnessing domestic delivery of treatment, UNAIDS predicts 7.4 million AIDS-related deaths can be averted by 2020. The report calls the strategies, “high-impact, high-value”.

Bernhard Schwartlander is the author of the Lancet paper and UNAIDS’s director of evidence, strategy and results. “Cost-effectiveness is always important, and especially important when resources come down globally,” he explains.

Economizing measures—such as shipping drugs by land rather than airlifts—have enabled HIV hotspots including Botswana and Rwanda to achieve universal treatment in the last two years despite decreased international funding. But UNAIDS acknowledges that it cannot offset resource reduction for too long, and unless more money is found, they will not reach their 2015 goal for 20 million people on treatment.

“The time is over when we can only rely on tradition mechanisms for getting money,” says Schwartlander. UNAIDS has promised a further report in the next year more forcefully exploring non-traditional funding sources.


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    david frenkel md said:

    Very interesting article ; informative, concise, well written. Thanks for the update. d frenkel m.d.

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    Sam Frenkel said:

    I would love to hear more about where UNAIDS is planning to get this extra funding from. Especially while the world seems to be going through economic crises. Great article.