The 20th International AIDS Conference in Melbourne, Australia offers an opportunity for humanity to look at past achievements in the global response to AIDS and face the challenges ahead in reaching the ultimate goal of an AIDS-free generation, where new infections are prevented and effective health systems provide long-term support to those living positively on treatment.
However, the theme of the conference, “Stepping up the Pace,” poses tough questions: How do we sustain the response to HIV in the current global economic environment in which donor funding is declining?
“Stepping up the pace” will require increased funding directed toward the global response to HIV and leveraging the potential of public-private partnerships to maintain and increase access to quality health services.
Increasing involvement, investments in country financing
Limited global resources — coupled with the rising costs of care due to earlier initiation of clients on antiretroviral therapy and the inclusion of all HIV positive pregnant women in prevention as treatment programs — shifts greater responsibility for HIV programs toward local governments and communities.
This calls for using improved financial and program planning by governments to make smart investments for sustainable impact. It will require mobilization of additional domestic resources, including from the private sector, and require a focus on cost-effective interventions that address HIV program inefficiencies. And last but not least, it will require increasing the quality and accessibility of health services down to the primary health care level as antiretroviral therapy becomes a matter of chronic care.
Many countries affected by the epidemic have growing economies which can significantly contribute to additional funding for the response. For example, in sub-Saharan Africa — a key region affected by the epidemic — Nigeria’s economy has been growing and has now officially surpassed the economy of South Africa, making it the largest country economy on the continent.
The Nigerian government is working with partners — particularly the USAID-funded Health Finance and Governance Project — to devise ways to increase its funding of the AIDS response in the country. Similar work is ongoing throughout the continent in countries with relatively substantial economies to increase national and sub-national governments’ contributions to funding aspects of the AIDS response. This kind of indigenous funding from national and sub-national governments is critical to the success of stepping up the pace in future global responses to HIV.
Critical role for the private sector
The private sector represents a broad range of potential partners that could be engaged to accelerate achievement of an AIDS-free generation; the private sector’s significant human, logistical and financial resources that could be leveraged to meet essential and chronic health needs in many high-HIV burden countries.
In many countries, there is an existing, vibrant and capable private health sector with additional capacity to provide counseling and testing, care and treatment, as well as long-term support for chronic illnesses. Partnerships with the private sector allow for greater reach by increasing the number of available service delivery points. The private sector can also help achieve equitable access to HIV-related services by removing financial barriers to care through tools such as vouchers and low-cost health insurance.
For example, Namibia became in 2012 the first country to cover voluntary medical male circumcision through private health insurance as an HIV preventative benefit. The USAID-funded Strengthening Health Outcomes through the Private Sector project worked with the public and private sectors to standardize the fee for the procedure and train private providers so that more Namibian men and boys could access this benefit. In Malawi, SHOPS worked with the Malawi Business Coalition for HIV and AIDS, the Malawi TB Control Program and the Malawi HIV and AIDS Control Program to increase the number of approved private health providers delivering integrated HIV/TB services in partnership with government. SHOPS is also working in Ivory Coast to establish a private provider network for the delivery of antiretroviral therapy in partnership with the government.
To achieve an AIDS-free generation, we must solve a variety of financial, human resource and infrastructure challenges. Doing so will require the involvement of new partners, such as the private sector, and innovative financing to make this goal a reality.
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Catherine Thompson is principal associate and strategic lead for HIV and AIDS at Abt Associates. Before joining the organization in early 2014, Thompson served as regional director for several programs in Africa and Zambia country director for FHI 360, and also worked on HIV and AIDS for USAID in Namibia and Nepal.