It’s not much fun representing an NGO at the World Health Assembly (WHA). Professional associations like IAS are allowed “Observer status” at UN meetings. This is definitely a government gig – a little bit shocking for those of us lulled by the rather inclusive style of new AIDS approaches like the Global Fund. But the UN is all about the world’s governments. That’s not always a bad thing. Big government gatherings can have important outcomes – making resolutions and guidelines that change how governments do things for their people. And of course WHO has a vital role in setting health standards and advising Health Ministries on effective responses. But there is often a risk that those who reach the elevated state of government simply don’t know what will make a difference for the people they serve – and they are subject to the lurches of political interest and change. For AIDS and development this is often dangerous. Development takes time; AIDS can’t be solved with “quick fixes”.

This is a defining year for AIDS, 2010 is the deadline established by the international community to achieve universal access to HIV prevention, treatment and care for all those in need. Sadly the WHA planners hardly seemed to notice that this is a special year for AIDS, but then this is nothing new. AIDS rarely makes it on to the agenda of the WHA, so the only way anyone could speak about AIDS was to intervene (if allowed) in the debate on the Millennium Development Goals (MDGs). And for a civil society “Observer” that meant jumping through a large number of tedious bureaucratic hoops. More...

The outcomes of last week’s Global Fund Board meeting brought relief and joy. Many people, fearful that planned discussions about prioritizing and financing for the next round of funding could damage the Global Fund’s collaborative spirit, went into the meeting thinking it could be the toughest yet.

Against a tough back drop of financial uncertainty, the Board’s decision to launch Round 10 on 20 May with an innovative new fund to support programmes for marginalized populations proved to be an important step forward in the Global Fund’s maturation.

As usual, the Board meeting made for an intensely busy week with late-night gatherings proving key to working through the issues at hand. Global Fund Chair, Ethiopian Health Minister Tedros, agreed that IAS could attend the meeting as an Observer. We hope this role will continue, given the importance of the Fund’s work to our membership, who play a central role reviewing applications on the Technical Review Panels, serving on Country Coordinating Mechanisms and delivering programmes supported by the Global Fund.

Setting funding priorities is inherently about choices. In the lead-up to the meeting it looked as though the Board would face tough choices that could pit low- and middle-income countries against one another, knowing that resolution on prioritization was key to deciding whether, when and how 10 would be launched. With a cap? With a waiting list? And who would be first on that list? These questions are most acute now because with the Replenishment process kicking off, no one knows how much money will be in the bank at the start of next year – and the Fund is only allowed to make grants up to the amount of real cash it holds. More...

A study published by The Lancet this week brings welcome news of significant reductions in maternal deaths and cites access to HIV antiretroviral therapy as a major contributor to reduced death rates among women. It is among the most compelling evidence to date that HV services do not compete with other health priorities in the developing world, they support them.

Photo: WHO/UNAIDS/E. Miller

The study shows once again that access to HIV prevention, treatment and care are essential to a comprehensive approach to improving developing world health because they:

• reduce all-cause mortality
• improve maternal health
• improve child health by preventing and treating HIV disease in children and reducing diarrheal and other diseases through safe breastfeeding
• reduce tuberculosis and other infectious diseases that exploit HIV-weakened immune systems
• support health worker training and strengthen developing world health systems.

Looking at maternal health in 181 countries over a span of almost 30 years, the study offers yet more proof that concerted, evidence-based action to improve the health of vulnerable populations works. More...

I’m still not really sure what came out of the Global Fund Replenishment meeting in The Netherlands last week. I sat through two days of donors delivering their talking points, chatted in several corridors during coffee breaks, have read the rather bland Chair’s summary several times, and the big question remains: will there be more money?

The people round the table in Den Haag were the Fund’s friends. These are donor representatives who will encourage their Ministers and bosses to find the money. Through most of the meeting they seemed to accept the case for the Fund to think big and aim for its top scenario to fundraise $20 billion for the next three years (2011-2013). This is the top level that would put a total of 7.5 million people on ARVs and provide annual care for 4.4 million orphans and vulnerable children, and access to PMTCT for 1.1 million women. This is the track to universal access. And as the civil society representatives at the meeting said – this is the minimum requirement.

But by the end of the second day, as the donor representatives settled back in to familiar routines negotiating the Chair’s summary, these ambitious goals seemed to fade. More...