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AIDS 2012

Laura Lopez Gonzalez Report back to Intl Womens Media Foundation Fellows 27 August 2012

Funding Most at-risk vulnerable populations (MARPs)


Men who have sex with men Commercial Sex Workers Mining communities

AIDS-Free Generation
Can we use new science, technologies to end HIV epidemics in a climate of financial austerity?

New releases related to South Africa

Major issues

Conceived at the 2000 G8 summit in Japan, the Fund garnered more than US$ 2 billion in pledges when it was launched in 2002 By 2009, the Global Fund had put almost 2.5 million people on treatment and was underwriting about half of all HIV treatment in developing countries. It had also grown to account for two-thirds of TB funding worldwide in an effort to tackle the leading cause of death among people living with HIV. In 2009, almost 15 percent of donor pledges to the Fund went unpaid; in 2010, almost a quarter of donor pledges failed to materialize In 2011, the Fund is forced to cancel its Round 11 of funding.

The Global Fund - Background

Consultations with civil society, governments etc. on how the Fund will change, especially how countries will be able to able for money in the future
Will middle income countries like South Africa and Namibia be prohibited from applying? What will this mean for key populations? How will the application process work?

The Fund at AIDS 2012

With PEPFAR, the United States is now the largest government donor to the HIV response globally accounting for about 54 percent of funding internationally, (UNAIDS) In an election year, PEPFAR seems to be one of the few issues with bi-partisan support but the flat-lining of funding looks to continue

President's Emergency Plan for AIDS Relief

Overview of international funding here South Africa receives a relatively small proportion of Global Fund money but this money and, more importantly, PEPFAR money are being scaled back
How will donor-supported patients be transitioned to the public sector? Do national governments have the money to take up care?
With a goal of initiating 400,000 patients on ARVs annually, the South African treasury has projected shortfalls in funding to maintain this pace in the next four years

Effects are already being felt in the region

Why this matters?

The First to Go: How Communities are being affected by the Global Fund Crisis

Laura Lopez Gonzalez, OSISA Research Consultant laura.lopez1@gmail.com AIDS 2012, 27 July 2012

Between March and April 2012, OSF contacted 35 CSOs in Swaziland, Malawi and Zimbabwe 32 were interviewed An additional 12 interviews were conducted with highlevel contacts representatives from the Country Coordinating Mechanisms (CCMs), national HIV and TB coordinating bodies, and United Nations agencies to provide a broad overview of civil society dynamics and Round 11 cancellation's impact. Draft was fed back to participants for fact checking

Methods

Swaziland: buffer stocks of antiretrovirals (ARVs) and the lab reagents for CD4 count and toxicity testing; OVC and PLWH support Malawi and Zimbabwe: TB drugs, TB diagnostic support, HW salary support, additional Microscopists and health Health Surveillance Assistants, who are responsible for a broad range of activities that includes HIV counselling and testing, infant HIV testing and condom distribution Zimbabwe: Expanded GeneXpert roll out, and support to improve lab culture capacity; advocacy component on paediatric TB aimed at health workers Malawi: OVC, PLWHA support; support for community sputum collectors Malawi and Swaziland: First apps to include MARPs

Country wish lists

Year 2012 2013 2014 2015

Projected Treatment Gap 66,500 About 71,000 87,000 361,000

Zimbabwe

Half were most likely dependent on GF funding Two-thirds reported that their work in community programme design and delivery had been impacted. Half said work with MARPs had been affected

Civil society impacts

Associations, support groups of people living with HIV Organizations operating at the district and community level
In Swaziland, SWAPOL has closed its legal aid unit, which focused on defending women's rights to property, for example, in a country where women are legally still minors Two-thirds of the CBOs that originally comprised the Tsabango HIV/AIDS network of 30 organisations In Malawi have closed The Swaziland National Network of People Living with HIV and AIDS (SWANNEPHA) is facing closure, as are some of its local affiliates that provide adherence support and defaulter tracing to local clinics

Hardest hit

Questions as to how politically unpalatable populations will be supported without the Global Fund US, the largest donor, re-affirms commitments to these populations, MSM, sex workers in a speech by Sec of State, Hilary Clinton that has created a designated funding stream for these More calls for the decriminalisation of sex work, with SWs setting up parallel summit in India
SA (SANAC) recently launched its first sex work plan Session on the new SADC Mining Declaration

MARPs

A time when, first of all, virtually no child anywhere will be born with the virus. Secondly, as children and teenagers become adults, they will be at significantly lower risk of ever becoming infected than they would be today no matter where they are living. And third, if someone does acquire HIV, they will have access to treatment that helps prevent them from developing AIDS and passing the virus on to others.

AIDS-free Generation

Will guide US HIV funding Speaks to using new science and technology
Medical Male Circumcision Treatment as Prevention
In 2011, HPTN-052 showed a 96% reduction in HIV transmission when patients were started on treatment earlier; projects now underway to see what this will mean in SA

Alongside continued scale-up of PMTCT

AIDS-free Generation

Routine TB vaccine could increase risk of HIV in HIVexposed infants, esp if not receiving PMTCT or breastfeeding mumsare not on effective treatment
This vaccine is already not recommended for HIV-positive babies

New SA study releases

Lots on Treatment as Prevention (TasP)


Cost-effectiveness modeling showed that high ARV coverage + MMC provided same reduction in new HIV cases as TasP, arguing for the prioritization of MMC Universal Test and Treat (annual screening and immediate ART for HIV infected adults [aged 15+])
New higher ARV initiation threshold seems to be decreasing new infections Concluded model would be cost-effective But unlikely to lead to the elimination of HIV in SA

New SA study releases

Findings from the 3rd South African National HIV Communication Survey (Soul City, John Hopkins)
Condom use at first sex is now a social norm More than 100 million South Africans have tested for HIV in the past 12 months Communication programmes have increased MMC demand Stigma is reducing 8/10 South Africans are reached by HIV communications programmes

Other releases

Abstracts are available online at http://www.aids2012.org/sitemap.aspx Scarce media scholarships are available annually through the IAS

Additional info