Funding the end of an epidemic: #WhyNow?

By True Claycombe 14 July 2016

Frank, a Tingathe community health worker, explains the results of a HIV test to a couple expecting their first child at the Kawale health center in Lilongwe, Malawi. Photo by: Robbie Flick / Baylor College of Medicine Children's Foundation - Malawi / CC BY-NC-ND

HIV/AIDS is a crisis that we must continue to fight, both around the world and in the United States. Younger generations lack an understanding of this crisis, as they did not witness the thousands of devastating HIV/AIDS deaths throughout the United States in the 1980s and 1990s.

Significant progress has been made, but those efforts are not enough — without careful decision-making and steady investments in the HIV/AIDS fight over the coming months and years, we stand to not only lose the gains made to date, but miss an opportunity to see the end of AIDS in our lifetimes.

Progress in the fight against HIV/AIDS to date

The ruthless disease that infiltrated U.S. communities during the early years of the HIV/AIDS crisis fueled an aggressive response by the U.S. government both nationally and globally. In 1990, with bipartisan support, Congress passed the Ryan White Comprehensive AIDS Resources Emergency Act, which was and is the largest federal program focused exclusively on providing HIV care and treatment services to people living with HIV in the United States.

The President’s Emergency Plan for AIDS Relief and the Global Fund to Fight AIDS, Tuberculosis and Malaria were created in the early 2000s to combat the epidemic on a global scale.

Globally, these efforts have been successful in averting 8.8 million deaths; however, we must aggressively continue fighting because people are still dying from HIV/AIDS (an estimated 1.2 million in 2014 alone).

Additionally, there are currently 90 million people worldwide that still do not know if they have HIV, and an estimated 50 percent of people living with HIV are not receiving treatment or care. We — the global community — have the ability to save 21 million lives and prevent 28 million new HIV infections by 2030 if we act now.

Where funding to fight HIV/AIDS stands today

We must continue to draw the world’s attention to the HIV/AIDS crisis. This is a big year — and a historic opportunity — to win the fight and save lives. World leaders came to New York for the High-Level Meeting on Ending AIDS on June 8, 2016, and committed to the Political Declaration on Ending AIDS, which includes specific, time-bound targets that must be met in order to end the HIV/AIDS epidemic by 2030.

In order to accomplish this, world leaders agreed to the UNAIDS Fast-Track approach which outlines the ambitious 90-90-90 plan: 90 percent of all people living with HIV to know their status; 90 percent of all people diagnosed with HIV to receive sustained antiretroviral therapy; and 90 percent of all people receiving antiretroviral therapy to have viral suppression.

During the HLM, major announcements were made in support of ending the epidemic by 2030. The United States announced the launch of a new $100 million Key Populations Investment Fund to increase HIV services for key populations.

Key populations include women and girls, men who have sex with men, and other subpopulations of individuals who are most vulnerable to HIV/AIDS. While this was a win in many ways in the fight against HIV/AIDS, we still have major gaps in financing. In the Political Declaration, world leaders called for relevant stakeholders to fund the gap in resources for HIV/AIDS, but an answer to the question of how exactly it will be financed remains vague.

Why now is the time to move the fight forward

In order to reach the goal of 90-90-90 by 2020, $26 billion a year is needed. This funding will be a combination of public and private investments, from increases in domestic financing from implementing countries, and donors like the Global Fund, PEPFAR and UNAIDS. The Global Fund set a target of raising $13 billion in its next three-year (2017-2019) cycle of funding. The Global Fund’s Investment Case outlines that this $13 billion could save 8 million lives, avert up to 300 million new infections across all three diseases, and lead to up to $290 billion in economic gains in countries where the Global Fund invests.

However, some critics (such as Jeffrey Sachs) have claimed that the Global Fund’s target is too low, and that the HIV/AIDS community is overestimating how much will actually come from domestic financing. While it is not reasonable to completely discount domestic financing, we must be realistic in order for donor governments, including the United States, to continue to finance the fight.

With substantial support from the American taxpayer, the U.S. government has committed more than $57 billion to bilateral HIV/AIDS programs and $13 billion to the Global Fund from 2004-2014. The United States is the number one donor to the Global Fund and essentially sets the benchmark for what other countries are willing to commit. Thus, the United States must continue its leadership role in the fight against HIV/AIDS. #WhyNow? Because with continued and robust investments, we have an opportunity to be the generation that put an end to the epidemic and saved 21 million lives worldwide.

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About the author

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True Claycombe

True Claycombe is the policy manager at Friends of the Global Fight. In this role, she advocates for Friends’ legislative goals and provides research and analysis on major policy issues and external reports as they relate to the Global Fund, the three diseases, and global health more generally. True earned her M.A. in international development from American University. Before graduate school, she spent more than two years on Capitol Hill as a legislative assistant to Rep. David McKinley.


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