Bill & Melinda Gates Foundation

Up for Debate: Tackling AIDS Requires More Financing, Coordination, and Momentum

December 03, 2012

What will it really take to end AIDS? The Skoll World Forum and Impatient Optimists have co-produced a blog series to answer this question. We'll publish two posts/day over the next three days.

According to the latest report by UNAIDS, new HIV infections have dropped more than 50% in 25 low and middle-income countries. Last week, U.S. Secretary of State Hillary Clinton unveiled what she described as a  blueprint for an ‘AIDS-Free Generation’. There may not be consensus on how best to tackle the AIDS pandemic, but it is impossible to doubt the depth of global commitment. However, while we celebrate this progress, we must still confront the challenges ahead. What will it really take to end AIDS? We asked some of the world's leading experts and innovators—representing the UN Global Plan, mothers2mothers, (RED), Riders for Health, ONE Campaign, the Center for Gender Health and Equity, and the Gates Foundation—to highlight key challenges moving forward, and how we can overcome them.

Following three decades of progress in the fight against AIDS, a sense of optimism is taking hold across the international development community, rooted in a number of landmark scientific and field-based studies suggesting that bold, strategic investments can turn the tide against the disease.

Still, compelling scientific data alone is not sufficient for achieving change. Few heads of state have outlined what specific steps they will take to contribute toward this vision, and there has not yet been any meaningful effort to determine a division of labor among stakeholders to drive progress on specific AIDS targets. Consequently, there has been mixed progress on number of key indicators, including rates of mother-to-child transmission, treatment access, and new HIV infections. In particular, efforts to slow HIV transmission have been largely ineffective, with rates of new infections holding steady above 2.5 million annually for the past decade.

 Encouragingly, low- and middle-income countries are now financing more than half of the global AIDS response. 

At current rates of progress, the point in time at which the number of new HIV infections annually is surpassed by the number of people newly added to treatment annually—effectively, “the beginning of the end of AIDS”—will not occur until 2022. To achieve this goal by the end of 2015, the global community would need to add 140,000 people to treatment annually in addition to current rates of treatment growth, and would simultaneously need to double the rate of preventing new HIV infections.

So as we commemorate World AIDS Day 2012, what will it take to drive progress towards the beginning of the end of AIDS?

1. Financing
UNAIDS estimates there is an annual $6-8 billion global AIDS financing gap, and a growing pool of global actors must contribute to closing this gap. For some donors like the United States, this will mean sustaining financial leadership in spite of domestic budgetary pressures. For others, it will require a scaling up of resources through traditional and innovative channels. Particular attention should be paid to countries that have promised increases to their aid budgets in the coming years, such as the United Kingdom and Australia.

New resources must also come from BRIC African countries. Encouragingly, low- and middle-income countries are now financing more than half of the global AIDS response. But there is much room for growth: as of 2010, of 43 African countries for which data is available, only four had met their Abuja commitment to allocate 15% of government spending to health. If all African countries met this commitment by 2015, as much as $90 billion could be freed up for health, including new resources for AIDS.

“Without scaled-up financing, targeted programming, and expanded political will, millions of lives will hang in the balance.”

2. Coordination
Many current AIDS programs are not well coordinated amongst donors, with non-governmental actors, or with recipient nations. Additionally, although global AIDS targets have been adopted, few donors have outlined what their specific contributions will be toward achieving them, leading to a gap in accountability.

To better coordinate efforts, stakeholders should outline programmatic and financial shifts they will undertake as part of a new global framework. New investments should be channeled through national strategies, which in turn should be modeled after efforts to improve the targeting and cost-efficiency of treatment and prevention resources. Donors must consistently evaluate their bilateral AIDS spending to ensure the greatest efficiencies are achieved, and multilateral mechanisms should look for ways to improve the targeting of and outcomes achieved with their resources.

3. Momentum
2013 will provide key moments in which stakeholders can signal how serious they are about achieving the beginning of the end of AIDS. Strong financial support at the Global Fund’s fourth replenishment meeting will signal confidence in the Fund’s new model, designed to better target resources towards countries with the highest disease burden and the greatest need. With sufficient resources, the Fund will be well positioned to deliver significant results toward the beginning of the end of AIDS.

In 2013, global leaders will also discuss a new post-2015 global development framework. As leaders debate this new framework, they must not lose sight of the importance of finishing the job on the current set of Millennium Development Goals (including MDG 6 focused on AIDS and other infectious diseases). Without scaled-up financing, targeted programming, and expanded political will, millions of lives will hang in the balance. But with renewed urgency and concerted action, the world can transform the beginning of the end of AIDS from a vision to a reality and chart a course towards ending this pandemic.

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