Achieving the Millennium Development Goals Requires Continued Investment in Global AIDS

This article is part of a series on global AIDS issues to be published by RH Reality Check throughout December.  To find other articles in this series, search "global AIDS 2009." 

Significant progress has been made towards achieving universal access to HIV prevention, treatment, care and support for people living with and affected by HIV and AIDS. This progress is documented in reports by the World Health Organization, the U.S. President’s Emergency Plan for AIDS Relief, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and in many journals and media outlets.

However, over the last few years, instead of praising these achievements and reflecting on how we can use the model of AIDS treatment for other diseases, we have seen a “backlash” against the enormous efforts and in particular, the funding devoted to global AIDS. Numerous media and journal articles portray these life-saving efforts and the funding attached as culprits for the lack in major progress to reach other important MDGs – primarily MDG 4 (reduce child mortality) and MDG 5 (improve maternal health). Some articles go as far as to blame global AIDS funding and programs as a main reason that health systems remain inadequate and ill-equipped to manage the various health needs and crises of populations in developing countries. These analyses, however, fail to include the impact of World Bank-led health sector reform in the 1980s and 1990s and its contribution to the current situation.

The backlash on global AIDS has been exacerbated by the economic crisis and played out in funding priorities of donors. For example, the UK government’s HIV/AIDS strategy launched in summer 2008 focused on strengthening health systems with no specific funding target for HIV/AIDS.  The Italian government has announced that it will cut its Official Development Assistance (ODA) budget (i.e. foreign aid budget) by 510 million euros between 2009 and 2011. Other major European donors to the Global Fund such as the Netherlands and France are seriously considering cutting their contributions.  Finally, worrying signs from the US government point to the likelihood that President Obama will not support an expansion of PEPFAR in FY2011 despite bipartisan legislation authorizing the next five years of PEPFAR (FY2009-2013) at $48 billion—of which $39 billion is slated for AIDS, $4 billion for TB and $5 billion for malaria. A World AIDS Day 2009 document released on the PEPFAR website stated a greater emphasis on health systems strengthening, “From FY 2010 onward, PEPFAR will report on partner countries’ national achievements in service delivery and health systems strengthening, as well as PEPFAR direct contributions to those achievements.”

While AIDS activists fight for commitments to be honored and funding increased to continue the progress towards universal access commitments, reproductive, maternal, newborn and child health advocates fight for donors to put their money where their mouths are. To date, despite all the rhetoric by donors that more needs to be done to get MDGs 4 and 5 back on track, little money has been committed to the cause.

At the end of the day, funding devoted to AIDS and to other diseases and health conditions are, in many instances, targeting the same people. The MDGs should be viewed as a framework to work towards but not the end in itself. We should not allow donors to swing the pendulum from one health priority to another. Rather, we need to call on the US and other donors to increase overall global health spending in a sustained and long-term approach that does not pit one disease against another or the success of one program to the detriment of another.