During the past decade, the US (58% of funding came from the US) and other developed nations created a massive anti-HIV/AIDS effort in the hardest hit countries. But as the previous decade wore on, there was increasing concerns that the effort was unsustainable. By focusing primarily on emergency care (the provision of lifesaving anti-retroviral drugs) the governments of the world were essentially pouring money into a bottomless pit. The spread of HIV/AIDS needed to be stopped. Plus funding needed to be less reliant on governments, with private giving picking up the slack.
And there was a growing chorus of opposition which said that the focus on HIV/AIDS was ignoring other diseases and medical problems which, if addressed, could save more lives for less money.
As the global recession began to take hold, other governments began cutting their funding. The US merely leveled off its funding, essentially capping it. But it seems clear that the First World nations, who provided the bulk of funding during the past 10 years, have grown tired and worried about the money that foreign anti-HIV/AIDS efforts are costing them.
The gap between U.S. ability and patient needs is one reason that the administration has emphasized a need to get other donors on board, in addition to local governments. The $50 million cut to the Global Fund, however, has been met with concern by the same groups that have criticized Obama’s global-health policy, and Kazatchkine calls it “a big test for the multilateralism and the move to multilateralism for the administration.”
The bigger test will be whether Obama’s health initiative can really build the environment that would be conducive to a shift from emergency to long-term HIV treatment, strengthening health-care systems where many have tried before and failed. In an ideal world, there would be enough money to fund both emergency and long-term solutions. But here’s the truth: There isn’t. So this was an inevitable juncture: A global recession, constrained budgets across the developed world, and a simple realization that treating HIV/AIDS is expensive have forced the U.S. government and other governments to answer hard questions about how their dollars will be spent. If Obama can make those hard decisions and manage the transition from emergency to long term, the fight against HIV/AIDS will be on a more sustainable footing. A wrong turn, however, could endanger the incredible gains made in recent years. And that’s what advocates fear most of all.