In another signal that the global battle against AIDS is falling apart for lack of money, the Global Fund to Fight AIDS, Tuberculosis and Malaria failed on Tuesday to reach even its lowest “austerity level” fund-raising target of $13 billion — the amount it had said it needed just to keep putting patients on treatment at current rates.
Tyler Hicks/The New York Times
Parents and a younger daughter in Uganda have H.I.V. but only the daughter is eligible for drugs.
Three-year pledges from 40 countries attending a two-day conference held in Manhattan amounted to $11.7 billion. The pledges were announced at the United Nations. The fund had hoped to raise $20 billion to catch up with the growing epidemic.
No one now on treatment will be cut off, said Dr. Michel Kazatchkine, the fund’s executive director, but the targets for the next few years must be lowered.
He said that he “deeply appreciates” the amount raised, but that “we need to recognize that it’s not enough to meet expected demand and will lead to difficult decisions in the next three years.”
He could not, he said, estimate exactly how many deaths would result.
The fund pays for AIDS drugs for almost three million patients now, and still might be able to reach four million by 2013. It had hoped to reach five million or more.
It supports about half of the world’s poor who are getting treatment. The President’s Emergency Plan for AIDS Relief, or Pepfar, started under the administration of President George W. Bush, pays for the other half.
An estimated 33 million people are infected worldwide, a number that grows by a million people a year after adding new infections and subtracting deaths.
Of that number, about 14 million are already so sick that, under World Health Organization guidelines, they should be on drugs. It looks increasingly likely that that number will outpace the number getting drugs.
The United States pledged $4 billion, which is a nearly 40 percent increase over its previous contribution. It is by far the most generous donor, and most countries raised their contributions by less.
France, Canada and Norway went up by 20 percent, Japan by 28 percent. Britain, Sweden and the Netherlands could not commit because of budget cycles, but were expected to be in that ballpark; Italy and Spain gave nothing. South Africa, which has the world’s worst AIDS epidemic, made a token contribution of $2 million. Russia and China gave $60 million and $14 million respectively, far less than fund officials had hoped. To reach the fund’s $20 billion goal, all countries would have had to roughly double their giving.
AIDS activists vented open frustration, both with the overall result and the American contribution.
“This is a modest course correction, not what we were hoping for in terms of U.S. leadership,” said Dr. Paul Zeitz, executive director of the Global AIDS Alliance, an advocacy group that had lobbied the administration for a $6 billion contribution. “This took the other donors off the hook. Everyone could aim low.”
By not reaching a decision earlier, he complained, the United States dithered away its leverage over other countries.
Under American law, the United States can contribute only one-third of the fund. If it had told other donors privately weeks ago that it intended a 40 percent increase, they would have been under pressure to match that, both to avoid sounding cheap, and because the United States cannot pay unless its donation is matched 2 to 1.
Dr. Eric Goosby, the global AIDS coordinator, said the intra-administration debate about how much to pledge was “robust” and went on right up until Tuesday morning.
“We’re proud of the pledge,” Dr. Goosby said in a telephone interview. Getting the United States, which has a one-year budget cycle, to commit to a three-year pledge was “swimming upstream,” especially in such a weak economy.
The battles against malaria and tuberculosis will also suffer, but the effect on AIDS is easier to measure. Malaria waxes and wanes with hot weather and local spraying. The TB epidemic echoes the AIDS epidemic because so many people have both, but TB can be cured in six months, which shrinks case counts rapidly.
Neil MacFarquhar contributed reporting from the United Nations.
http://www.nytimes.com/2010/10/06/world/africa/06aids.html
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