Nestled along the northern shore of Lake Victoria, the remote Ugandan fishing village of Lambu is a temporary home for many. The community works to make a modest living here before moving on in search of economic opportunities elsewhere.
To the untrained eye, Lambu may appear to be a typical village — fishermen mending nets on the shores, women selling goods, and children running in the streets — but a closer look unveils the suffering that takes place along its banks.
Lambu has one of the highest rates of HIV in Uganda, with fishing communities in the country reported to have HIV incidence rates over four times higher than the general population. This issue is compounded by the double burden of HIV and tuberculosis that is common in Uganda, which the World Health Organization has listed among the nations with the most HIV-associated TB.
I had the opportunity to visit Lambu earlier this year and explore the deep-rooted systemic factors — social, physical, and economic — that impact the health of this community. A lack of health care services, a mobile population of fishermen who have multiple sexual partners, and women supplementing their low income with sex work all contribute to the HIV epidemic.
Inadequate housing and overcrowding also put this population at risk of airborne infectious diseases, such as TB and COVID-19. With TB being the leading cause of death among people living with HIV, co-infection is a serious concern.
Finding solutions
Unfortunately, the situation in Lambu is not unique. Cycles of poverty fuel long-standing HIV and TB epidemics — despite the existence of treatments and preventive measures — in many similar communities across low- and middle-income countries. The lived experiences of people in Lambu highlight the complexity of addressing health issues that are rooted in inequity and underscore the need for community-based interventions that address cultural and social considerations.
In terms of what the international community can do, the Global Fund to Fight AIDS, Tuberculosis and Malaria is a proven mechanism working to end these diseases and the preventable suffering they cause. The international partnership supports a people-centered, localized approach to care that has saved an estimated 44 million lives since its creation in 2002.
The Global Fund has played a particularly important role in the quest to end TB, providing 77% of all international financing for the disease. Given the disproportionate setbacks that TB programs have faced during the COVID-19 pandemic, the Global Fund is our best bet to getting back on track to ending this preventable and curable disease.
Time to act
Due to the massive disruptions that COVID-19 caused, deaths from TB and malaria have increased for the first time in years and much progress on HIV has stalled. That’s why the Global Fund’s seventh replenishment this year is critical. Its investment case calls on the world to mobilize $18 billion to save a projected 20 million lives over the next three-year funding period. Due to increased need amid the pandemic, this is about 30% higher than the $14 billion raised at the Global Fund’s sixth replenishment in October 2019.
Since this call for funding, civil society organizations from around the world have worked together to ensure that donor countries meet the required figure. In Canada, for example, organizations such as Results Canada are calling on the government to pledge 1.2 billion Canadian dollars to the Global Fund and for Prime Minister Justin Trudeau to announce this commitment at the International AIDS Conference starting on July 29 in Montreal.
In coalition with organizations from across the country, Results Canada has been involved in public and political engagement to put pressure on the prime minister to make this commitment. Through our collective advocacy, including public-facing educational campaigns and parliamentary meetings, we have secured strong support from parliamentarians across party lines for an increased commitment to the Global Fund.
The Global Fund is specifically looking to the leading industrial nations in the Group of Seven, including Canada, to increase their pledges by 30% from the sixth replenishment. So far, the U.S. is the only G-7 country to announce its intention to commit its fair share, totaling $6 billion.
Due to a U.S. law preventing the country from providing more than one-third of the total value of Global Fund contributions, securing the full $6 billion will be dependent on ambitious pledges from Canada and other G-7 nations. If donors do not collectively get to the full $18 billion, U.S. funding will be left on the table.
The stakes are huge. We will either see donor countries step up in support of this high-impact mechanism by investing in saving lives and human potential, or we risk needlessly losing millions of lives and abandoning the Sustainable Development Goal target of ending TB, malaria, and AIDS by 2030.
Advocates around the world are hopeful that Canada will use this opportune moment in Montreal to reaffirm its reputation as a leader in global health. An ambitious pledge from Canada would not only be cause for celebration on its own but would also set a precedent for the G-7 countries that have yet to commit to stepping up support to the Global Fund.
An investment in the Global Fund is an investment in Lambu and the remote communities around the world that continue to battle epidemics head-on. It’s an investment in equity and solidarity, and one that will dictate whether millions of people live or die of preventable diseases.
Visit the Talking TB series for more coverage on how we can eliminate tuberculosis by 2030. The time for a paradigm shift and a renewed focus on funding, research, and global solutions is now. Join the conversation by using the hashtag #TalkingTB.
About the author
Leigh Raithby
Leigh Raithby is a policy and advocacy officer at Results Canada, a nonprofit advocacy organization committed to generating the political will to end extreme poverty, where her work focuses on tuberculosis. Leigh is also a secretariat member of Stop TB Canada, a network connecting people, organizations, and communities committed to ending tuberculosis at home and abroad.
