Over the last couple of weeks we’ve witnessed two key events that will shape global health and the HIV response over the next five years. I’ve closely followed the recent developments and outcomes at the MDG Summit and the 3rd Voluntary Replenishment of the Global Fund to Fight AIDS, TB and Malaria. For those of us working in the field of HIV the importance of the Global Fund Replenishment could not be overstated. I waited for the outcome of the replenishment meeting with cautious optimism.  After almost a decade of increased financial support for the Global HIV/AIDS response, this past year has been marked by funding flat lining. Donor countries have blamed the economic crisis for reductions in development aid, however there are growing concerns that the tide has turned away from AIDS funding and that political will in taking the HIV/AIDS response to the next level has waned.  The disappointing outcome of the Global Fund Replenishment Meeting reinforces my concerns.

In the past year the Global Fund has released three funding scenarios in preparation for the Replenishment meeting.  At the lowest requested funding level of $13 billion the Global Fund would be able to maintain their current commitments.  The second funding scenario of $17 billion would allow the Global Fund to scale up moderately and the third funding scenario of $20 billion would allow for a significant scale up that would bring us much closer to reaching both the health related MDG targets and the universal access targets.  Unfortunately the financial commitments at the Replenishment Meeting failed to reach even the lowest funding scenario of the Global Fund with a total commitment of only $11.7 billion announced as the final outcome.  The US remains the largest contributor to the Fund with a pledge of $4 billion for the replenishment period which is a 38% increase on its previous pledge.  The average increase of other donors was approximately 20%, but to meet the $20 billion target set all Global Fund donors needed to double their contributions.

The Global Fund has been able to demonstrate that its programmes have broader benefits than just MDG 6.  They have also made a significant contribution to both maternal and child health and also to health system strengthening.  A new Global Strategy for Women’s and Children’s Health was launched at the MDG Summit, and considering that AIDS remains the leading cause of death of pregnant women globally a scaled up and robust HIV/AIDS response will be a prerequisite to the success of this Strategy.  A fully funded Global Fund would have significantly contributed to a reduction in both maternal and child mortality as well as reducing the crippling burden of AIDS, TB and malaria.   

This has been a critical year for global health and in particular for the HIV/AIDS response as this was the year set by the international community to achieve universal access to HIV prevention, treatment and care. 

The universal access goals will not be achieved this year and the substantial progress that has been made over the last decade in the fight against HIV/AIDS may well be reversed due to waning political and financial support. 

We have 5.2 million on treatment, but another 10 million people waiting. So governments must redouble their efforts. It is critical that the HIV/AIDS community responds to these new challenges and that we continue to hold all governments accountable for promises made to HIV/AIDS and global health.  I believe we can and we must overcome these challenges, otherwise the lives of millions of men, women and children are at stake.  The fight for universal access is far from over, the gap between available funding and need is widening; and an effective response from the HIV/AIDS sector is critical.  We must intensify our efforts and demand universal access to HIV treatment. We must shout together and create a wall of sound that is too loud to ignore.