AIDS Alert International: Despite boost from U.S., Global Fund faces a struggle

Some groups wonder if Fund’s time is over

The Global Fund to Fight AIDS, Tuberculosis, and Malaria’s ability to fund its third round of grant proposals was uncertain by early summer, as the G-8 summit produced little response to the United States’ challenge to fellow wealthy nations to more fully fund international AIDS efforts.

In time for the June G-8 summit, the U.S. Congress passed a bill providing $15 billion over five years toward international AIDS treatment and prevention services. Up to $1 billion of that total could be send to the Global Fund each year, but was not a mandate.

"The discussion [at the Global Fund] is how on earth the third round of grant proposals will get funded, because the donors are too stingy to put in money for 2003," says Asia Russell, coordinator of international policy at Health GAP in Philadelphia.

Global Fund officials estimate that the fund’s current pledges through 2004 are not enough to finance the third, fourth, and fifth rounds of grant proposals, and that the fund needs about $3 billion by the end of 2004. In the first two grant rounds, the fund spent $1.5 billion on 153 programs in 92 countries.

The $1 billion promised by the United States is contingent upon other contributors anteing up three times as much money. While President Bush pushed Congress to pass the international AIDS bill, his support of the Global Fund has been less enthusiastic, critics charge.

Russell claims that it was the United States that gutted a document created at the G-8 summit that was supposed to encourage discussion and support for the Global Fund and generic medications.

"The document was basically useless," Russell says. "Instead of having a section devoted to the Global Fund which the G-8 launched, it had a passing mention of it."

Others discount the criticism.

"The bill that just got signed into law says the U.S. contribution to the Global Fund couldn’t exceed one-third of the fund’s allocations," says Marsha Martin, DSW, executive director of AIDS Action in Washington, DC.

But the president said that as the rest of the world contributes to the Global Fund, the amount the United States contributes will increase, and for the United States to hold back on that promise would only look bad, Martin says.

"For the first time in 10 years, if not 15, we have the U.S. Congress talking about AIDS, and when the bill was signed into law, there were 375 congressmen in the affirmative, and in the Senate, it was 100% unanimous," Martin says.

However, the big question is whether the rest of the world will contribute a fair share.

"The United Kingdom made a sham announcement of contributing $200 million over five years," Russell says.

French President Jacques Chirac said at the G-8 summit that his nation would contribute 150 million euros, but later he said the nation would triple that amount to 450 million euros, according to a Global Fund announcement.

"There is nothing coming from Germany, Japan, and Canada," Russell adds. "Japan has given $14 million over two years, and the spokesperson for the prime minister said there was no plan to increase or replenish Japan’s contribution, and Japan is the second in the G-8 as far as global wealth."

However, Britain has increased its commitment, and based on gross domestic product, Britain is contributing the most of any country in Europe, says Michael Weinstein, president and founder of AIDS Healthcare Foundation in Los Angeles.

Also, Italy pledged an additional 200 million euros, the Global Fund has announced.

Italy has been a more generous contributor on a per capita basis than most other nations, Weinstein says.

Created by U.N. Secretary General Kofi Annan in April 2001, the Global Fund was ratified at the G-8 meeting later in 2001, Russell explains.

"Chirac said at that time that the fund would need $10 billion a year to function and succeed," Russell says. "And right now, if many, many donors came through in a way they’ve indicated they don’t want to, then at best we’ll have a $3 billion fund."

Chirac and British Prime Minister Tony Blair asked European Union members to contribute $1 billion a year to the Global Fund in a joint letter to Greek Prime Minister Costas Simitis, who is the European Union president.

While it is possible that enough nations will come forward by September with pledges to keep the Global Fund afloat, these sorts of funding problems raise the issue of whether the fund will continue and in what capacity.

"I think that if the structure of the Global Fund remains as it is, then its efforts will be disabled indefinitely," Weinstein says.

Staunch critics of the Global Fund, including Population Research Institute of Front Royal, VA, would like to see it abandoned.

"It’s a lousy program," says Scott Weinberg, director of governmental/international affairs for the organization, which promotes abstinence-only HIV prevention programs internationally.

"The Global Fund doesn’t have much to show for itself, so why would we want to go that route?" Weinberg says.

Others disagree. Before the Global Fund was created, nations that wished to contribute to international AIDS relief often wouldn’t know where to send their money, Martin says.

"Now there is a place for that kind of infrastructure and macroeconomic response," Martin says. "So let’s put some money into it to make it effective."

Right now, Global Fund money is distributed through grants to communities in need, and there are oversight structures in place to make certain the money is spent wisely. For example, grant applicants are supposed to include in their proposals their plans for independent audits, and there is an independent verification of this process. Global Fund officials take pride in the fund’s transparency, and point to its detailed web site as an example of this. The web site (at www.globalfundatm.org) provides multiple examples of how various grants have been awarded and spent around the world.

Speaking from the perspective of a potential grant applicant, Weinstein of the AIDS Healthcare Foundation says the Global Fund requires applicants to go through the local governments with whom they will work, and that is a very time- consuming process.

"The AIDS effort in the U.S. was led by community organizations, and the same will be true globally, and I think community organizations are closer to the populations that are being cared for," Weinstein says. "They’re better able to affect behavior and convince people of the need for treatment and testing."

Weinstein also takes issue with the Global Fund’s accountability. "I don’t see how the Global Fund, starting from scratch, can have an effective accounting mechanism in 50 to 60 countries; and secondly, even if money is not lost in corruption, that’s not a guarantee that it won’t be lost in bureaucracy," Weinstein says.

Nonetheless, the Global Fund may be the AIDS community’s best shot at convincing wealthy nations to contribute to HIV/AIDS prevention and treatment, especially because the fund was created by wealthy nations. And it may be the world’s best example of how to transfer HIV/AIDS funds and expertise to the places most lacking and in need.

"The success of the Bush initiative is caught up to a large extent in the success of the Global Fund," Russell notes. "Initiatives established by the Global Fund need to be complementary with the Bush initiative, because the curve of these interventions is incredibly steep."