26 July 2012

AIDS: Turning the Tide or Riding the Wave?

The theme for the XIX International AIDS Conference in Washington DC is “turning the tide together.” Panels, organizations and speakers have seized on the theme by discussing the changing tide for just about every subject area that falls under the wide AIDS umbrella. “The technology has never been better to turn the tide toward an AIDS free generation,” said USAID Administer Shah on Tuesday.

A conference that is usually marked by excitement, both the cheers and jeers have been largely absent. What seems to fill the space are vague pleasantries and general calls to end AIDS. Erin Hohlfelder remarked on this after the first day of the conference in the ONE Campaign blog. “I did a quick review of all the speeches I had heard so far, and I realized they had essentially all said the same things, the same platitudes, and the same “inspirational words” over and over again. If I had collected a dollar for every time I heard “we can and must end this disease”; “we must turn the tide together”; “we’ve come so far, but we can’t stop now”; or “we’re at a tipping point” I might be well on my way to filling the current AIDS financing gap,” she wrote.

Funding remains a significant issue and something that gets a small mention in many sessions, yet its mentions are not leading to action. Unlike other high level confabs like the recent London Family Planning Conference and the Childhood Survival Call to Action, the IAC is not filled with splashy financial pledges by governments, the private sector and NGOs.

Activists departed the conference on Tuesday to march on the White House and make noise about AIDS. The loudest calls were for more funding. Activists called on governments to meet their commitments to the Global Fund. Mo Banjay, a Gambian youth, interrupted a panel featuring Senators Rubio and Coons to call on the members of Congress to continue to ensure funding continues to grow.

Bill Gates stands out as one of the few skeptics among a crowd of cheerleaders. He pointed towards the lack of vaccine as evidence that the tools needed to end AIDS are not yet available. “Only when we have these new tools can we seriously talk about moving toward the end,” he said.

Gates told AlertNet that it is necessary to ensure that AIDS funding remains a priority. The burden of HIV rests squarely on low and middle-income countries. $16.8 billion was spent globally for HIV prevention and treatment last year, but spending has largely flattened since 2009. The total funding still falls short of the estimated $22 to $24 billion needed to funding HIV/AIDS programs each year. The 2008 financial crisis and the recent scandal involving the Global Fund are in some part at blame.

The good news is that individual countries are increasing their domestic spending targeted at HIV/AIDS. UNAIDS head Michel SidibĂ© noted this in his remarks at the IAC, “Around the world, over 80 low- and middle-income countries increased their domestic investments for AIDS by more than 50% between 2006 and 2011. BRICS countries now fund, on average, more than 75% of their domestic AIDS responses. Last year, the South African government contributed almost 2 billion dollars.”

The Robin Hood tax is a solution to the funding gap that is beginning to gain traction. Sidibé restated his support for the mechanism in his IAC remarks and Gates has said many times before that he too supports it as a way to increase global health funding. The idea is that a small tax on the financial sector that can target an industry that is in a better position financially as a mechanism for raising money.

Supporters say that the little cost incurred on the individual will matter little to that person, but can add up to a lot of money in sum. Owen Barder shared his concerns in 2010 that such a mechanism, while effective in raising money, will do little to fundamentally change the problems that lead to the shortfall of aid funding.

“The development industry is right to say we should spend more on aid, but we are losing the argument. Instead of addressing the criticisms by demonstrating how aid is effective (and taking steps to make it more effective where it isn’t) we are turning to a Robin Hood tax apparently in the hope of bypassing public opinion… Building support for development is not merely a communications challenge, as is often implied by the hand-wringing of the big aid agencies: it is a reality challenge. Not only do we have to show people how their aid is used, we actually have to make aid more effective, more transparent and more accountable, so that we drive up performance,” said Barder.

As the conference continues, the issue of funding remains a point that is on the lips of nearly every panel, but has yet to move in a meaningful manner. Hilary Clinton announced $150 million in new funding from the United States, but that has been the biggest announcement thus far. A long way from the estimated $7 billion more needed each year.