South Africa

UNAIDS Goodwill ambassador, football player Michael Ballack during his visit to the Health4Men initiative.
Credit: UNAIDS/M.Safodien

In his role as UNAIDS International Goodwill Ambassador, the German football star Michael Ballack conducted a 3-day mission to Johannesburg, South Africa, where he learned about the impact of HIV on communities and used his star-power to raise public awareness of the epidemic.

On 18 January, the first day of his visit, he met with men who have sex with men (MSM), a key population at higher risk of HIV during a visit to the Health4Men initiative at the Yeoville Clinic in Johannesburg. The innovative programme provides free sexual health services to MSM, who often experience stigma and discrimination and struggle with a lack of services catering to their needs. Mr Ballack toured the programme, spoke with health providers and met with MSM.

“I think it is so important that we give attention to HIV because it is everybody’s business,” said Mr Ballack.

“Having somebody like Michael Ballack, who is a big, big celebrity come here to meet people living with HIV, I am very grateful for that and I am very happy,” said one of the Health4men’s clients.

“It is almost impossible to discuss MSM sexual issues openly in South Africa. This is why it is important for these kinds of services to be integrated, into mainstream health care services provided throughout the country,” said Glenn de Swardt, Programme Manager at the Health4Men site.

The Grassroot Soccer project in Soweto was on the itinerary on day two. Along with UNAIDS Executive Director, Michel Sidibé Mr Ballack spent time with participants of the programme. Grassroot Soccer uses football to deliver key life-skills to young people.

“Michael Ballack has done so much to raise awareness of AIDS and UNAIDS is so lucky to have him give his time, energy and name to the HIV movement,” said Mr Sidibé.

UNAIDS Goodwill ambassador, football player Michael Ballack delivering key life-skills to young people during his visit to the Grassroot Soccer project.
Credit: UNAIDS/M.Safodien

Mr Ballack also attended the opening of the 2013 Orange Africa Cup of Nations, which is the continent’s most prestigious football tournament. During the tournament, Mr Ballack met with the President of South Africa, Jacob Zuma as well as with other African Head of States, attending the event. UNAIDS launched its HIV awareness campaign, “Protect the Goal” during the opening.

South Africa has the largest HIV epidemic in the world with an estimated 5.6 million people living with HIV. During the past few years the country has made remarkable progress in reversing the course of the AIDS epidemic. Now, the country has the largest HIV treatment programme in the world with 1.9 million people living with HIV on antiretroviral therapy.

“I have really learnt a lot during this trip and I look forward to continuing to work with UNAIDS on stopping the spread of HIV,” said Mr. Ballack.

The football champion has been a UNAIDS International Goodwill Ambassador since 2006 and he has dedicated time and effort to disseminating HIV prevention messages through the media. 

UNAIDS International Goodwill Ambassador and football star, Michael Ballack witnessed how football is transforming lives in South Africa. On 19 January, he visited the Grassroot Soccer programme in Soweto, South Africa and watched a Skillz Street practice session involving about 50 boys and girls. Grassroot Soccer uses soccer to educate, inspire and mobilize communities to stop the spread of HIV.

Mr Ballack was joined by UNAIDS Executive Director, Michel Sidibé on his tour of the programme.  Mr Ballack is on a 3-day fact-finding mission in South Africa, where he is learning about how HIV impacts lives.

The campaign aims to harness the power of football to raise awareness of HIV

JOHANNESBURG, 19 January 2013— The President of South Africa, Jacob Zuma, UNAIDS Executive Director, Michel Sidibé and the President of the Confederation of African Football, Issa Hayatou launched the “Protect the Goal” initiative on January 19 at the opening ceremony of the Orange Africa Cup of Nations in Johannesburg.

The “Protect the Goal” campaign aims to raise awareness of HIV and mobilize young people to commit to HIV prevention. Globally, an estimated 4.6 million young people (15-24 years of age) are living with HIV. About 2 300 young people are infected with HIV each day. Many young people living with HIV, who are eligible for treatment lack access or do not know their HIV status. The “Protect the Goal” campaign also stresses the need for ensuring all the 15 million people eligible for life-saving antiretroviral treatment can access it by 2015.

“Accelerating large-scale efforts for HIV prevention and treatment is imperative in Africa,” said President Jacob Zuma. “With strong leadership from government and community support, South Africa is showing results and its commitment to ending AIDS.”

Earlier in January, the President of Ghana, John Mahama attended an event to send off the Ghana Black Stars National Football Team to the Africa Cup of Nations. During the event, President Mahama signed a pledge supporting the “Protect the Goal” campaign. The Captain of the Black Stars also signed and read out the pledge. As part of advocacy activities in the lead-up to the tournament, UNAIDS country offices were able to enlist the support of other national football federations to the Protect the Goal campaign. As a result, team captains from Algeria, Democratic Republic of Congo (DRC), Ethiopia, and Niger signed the pledge to support the campaign. Other countries are expected to join the initiative during the three week-long Africa Cup of Nations tournament.

During the Africa Cup of Nations, UNAIDS is partnering with the Confederation of African Football, the South African Football Association and the Tobeka Madiba Zuma Foundation to implement the “Protect the Goal” initiative. During the campaign, UNAIDS and its partners will disseminate HIV prevention messages on large electronic screens to football fans in all stadiums where the Africa Cup of Nations football games are taking place. The captains of each of the 16 teams participating in the games will read a statement calling on players, football fans and young people to support the campaign. The “Protect the Goal” campaign will continue until the 2014 FIFA World Cup in Brazil.

“Football appeals so much to young people and I am thrilled to have such a groundswell of support from the stars of African soccer,” said UNAIDS Executive Director, Michel Sidibé. “I know this is just the start of an astonishing campaign which will generate much enthusiasm among fans all the way to Brazil 2014.”

“We are extremely happy to support UNAIDS in their efforts to roll out this campaign across the continent,” said President of the Confederation of African Football, Issa Hayatou. ”Our teams are committed to an Africa where AIDS is no longer a threat.”

The 29^th edition of the Orange Africa Cup of Nations will last until 10 February, the day of the finale. It is the most prestigious football tournament on the continent and happens every two years. The sixteen teams participating in this year’s championship are: Algeria, Angola, Burkina Faso, Cape Verde, Côte d’Ivoire, Democratic Republic of Congo, Ethiopia, Ghana, Mali, Morocco, Niger, Nigeria, South Africa (host), Togo, Tunisia, and Zambia.

The President of South Africa, Jacob Zuma met with UNAIDS Executive Director, Michel Sidibé, on 18 January at the president’s official residence in Pretoria. Mr Sidibé congratulated President Zuma on the country’s achievements in the AIDS response in recent years and reiterated the support of UNAIDS. President Zuma acknowledged that although South Africa has in the past suffered from adverse policy decisions, the current leadership in the country is moving the AIDS response forward.

They discussed the role of South Africa in promoting the African Union’s Roadmap for Shared Responsibility and Global Solidarity, which outlines the long-term sustainable strategies to finance and providing access to HIV treatment and prevention services in Africa. The two leaders also talked about the need to reduce external financial dependency and use the HIV response to encourage technological innovation. South Africa is one of the few countries in Africa to produce antiretroviral medicine for HIV treatment and could serve as a model for the rest of the continent.

Mr Sidibé and the President also discussed the development agenda beyond 2015 and the influence that South Africa can have on the global debate around reaching new development goals.

UNAIDS Executive Director, Michel Sidibé met with the Deputy President of South Africa, Kgalema Motlanthe and the Minister of Health, Dr Aaron Motsoaledi on 18 January. The meeting began with a review of the progress made in the HIV response in South Africa in recent years. The Deputy President attributed much of the success of the country to the Health ministry and in particular, the Minister of Health. Dr Aaron Motsoaledi spoke about the country’s achievements, especially in reaching 70% of people, who need HIV treatment with life-saving antiretrovirals.

Mr Sidibé welcomed the advances the country has made but added that stigma and discrimination are still barriers to accessing treatment and that the silence surrounding people living with HIV needs to be broken. 

South Africa has, for the second time in a row, reduced the cost of procurement of antiretrovirals. Credit: UNAIDS/ A.Debiky

South Africa has, for the second time in a row, reduced the cost of procurement of antiretrovirals (ARVs) as announced by South African Minister of Health, Dr Aaron Motsoaledi on 29 November. ‘As far as we are concerned, South Africa has become the lowest price setter for ARVs in the world’, said Dr Motsoaledi to an excited audience at a packed press conference. The new agreed prices will save an additional US$250 million approximately.

Earlier in 2010, South Africa reduced for the first time the prices of the ARVs purchased following a change in its procurement approach. Since 2010, the National Department of Health has managed to reduce expenditure of ARVs by 53%. This translates to an estimated saving of US$ 685 million over a two-year period from 2011 to 2012.

‘What this essentially means is that more people in South Africa will have access to life-saving ARVs while keeping expenditure at its lowest. It is wonderful news’, said Dr Catherine Sozi, UNAIDS Country Coordinator in South Africa.

In addition, the Minister of Health announced that the new tender will be for fixed-dose combination ARVs—meaning that people who take ARVs will only have to take one pill once a day instead of three pills twice a day. The simplification of the regimen translates into fewer pills, fewer times a day and fewer side effects and will have a significant impact on the quality of lives of people living with HIV in South Africa. The triple fixed-dose ARV will be a combination of tenofovir, emtricitabine and efavirenz.

Local manufacturers in South Africa have been awarded 70% of the tender. ‘I am sure suppliers will understand that [the negotiations] are in the best interests of patients’, said Dr Motsoaledi. ‘We are now able to treat more patients with the same budget’.

Fixed-dose combination to all pregnant women

The Minister of Health also announced that all pregnant women in South Africa will receive fixed-dose combination during pregnancy and breastfeeding regardless of their CD4 count. If their CD4 count is below 350 antiretroviral therapy will be life-long.

South Africa has already achieved a significant drop in the rate of mother-to-child transmission (MTCT) of HIV in the last year—from 3.5% in 2010 to 2.7% at six weeks in 2011. With the introduction of fixed-dose combination it is expected that the rate will drop even further and make a difference during the breastfeeding period, which is where most new infections among children currently occur.

All of the changes announced yesterday will be effective from 1 April 2013.

Professor Sheila Tlou, Director of the UNAIDS Regional Support Team for Eastern and Southern Africa and Clive Tasker, Head of Corporate Banking International signed the memorandum of understanding between the Standard Bank Group (SBG) and UNAIDS.

The Standard Bank Group (SBG) and UNAIDS formalised, on 22 November, what had already been a long-term collaboration in the response to AIDS in sub-Saharan Africa. They signed an official memorandum of understanding (MoU) for an initial period of two years to further collaborate on AIDS education and advocacy initiatives in the workplace.

“Healthy staff and communities are high on the agenda for any corporate, especially those operating in developing countries.  Without a healthy workforce, economies can’t thrive,” said Clive Tasker, Head of Corporate Banking International. “As the biggest bank in Africa, we believe that we have a role to play in supporting government health objectives.  Our partnership with UNAIDS allows us to do so by working with a respected organisation to educate our staff and communities on HIV prevention and treatment, and remove the stigma associated with AIDS,” he added.

The SBG is the largest bank in Africa. It is represented in 33 countries (17 in Africa and 16 in five other continents), has over 600 branches in South Africa and over 400 outside of South Africa and employ more than 50 000 people worldwide (34 891 are in South Africa). Partnering with the SBG is providing UNAIDS with an opportunity to reach out to key communities in countries where the bank operates and where the epidemic is.

“Employers play a critical role in the AIDS response. UNAIDS is committed to bringing the knowledge, solid experience and the capacity of the private sector to the AIDS response,” said Professor Sheila Tlou, Director of the UNAIDS Regional Support Team for Eastern and Southern Africa.

The latest UNAIDS World AIDS Day 2012 report, shows that the acceleration in the AIDS response is producing unprecedented results. According to the report, the number of people accessing HIV treatment in sub-Saharan Africa reached 56%—compared to a global average of 54%. In 5 Southern African countries–Botswana, Namibia, Rwanda, Swaziland and Zambia more than 80% of people living with HIV who are eligible for treatment are receiving antiretroviral therapy. However, 7 million people still do not have access to life saving treatment which negatively impacts their wellbeing and the socio-economic development of their nations.

Project 90/90

Early in the year, the SBG piloted the ‘Project 90/90’, which aims to reach 90% of the Bank’s employees with comprehensive health assessments annually and place people in need on treatment within 90 days, by 2015. A typical 90/90 health assessment includes tests that check sugar levels, blood pressure, cholesterol, and HIV and TB status.

“If a staff member is at risk for any disease, it is our goal to get 90% of those staff onto a proper treatment programme,” said Dr Wendy Orr, Head of Inclusion at Standard Bank Group. During the six months that the pilot run in the Standard Bank Headquarters in South Africa, 6 500 out of the 16 000 of the Bank’s staff members underwent a 90/90 health assessment.  Of those, approximately 65% took an HIV test.  “We believe that by including an HIV test in a broad health assessment, we are starting to lessen discrimination—one of the key objectives of the UNAIDS ‘zero’ campaign,” said Dr Orr.  “Following the success of our pilot, it is our intention to scale up the number of tests we do so that by 2015 all staff across the group will be receiving 90/90 screenings annually,” she added.

Community outreach

In addition to the 90/90 project, SBG remains committed to its ‘wellness champion’ programme. This programme uses voluntary staff members of the Bank as ‘champions’ to conduct awareness and mobilisation activities in order to increase uptake of voluntary HIV counselling and testing as well as condom distribution at the workplace and in communities.

During the 2011 World AIDS Day commemoration period, the ‘champions’ in collaboration with UNAIDS reached communities in Ghana, Nigeria and South Africa where more than 4 000 people voluntarily tested for HIV. “Wellness champions are peer workers who do an amazing education and advocacy work within our organisation and in the communities we serve,” said Dr Orr.  “Our ‘wellness champions’ need access to quality healthcare information and our partnership with UNAIDS has been invaluable for the work that they do. They will continue to be crucial to our success as we extend our focus to the Standard Bank Group more broadly.”

The members of the High-Level Taskforce for Women, Girls, Gender Equality and HIV for Eastern and Southern Africa during their recent visit to South Africa

The High-Level Taskforce for Women, Girls, Gender Equality and HIV for Eastern and Southern Africa concluded a week-long political advocacy mission to South Africa calling for renewed commitment and leadership to protect the health and rights of young women and girls in the country.

South Africa’s Department of Women, Children and People with Disabilities invited the Taskforce to advocate with the country’s leadership around the critical issues facing women and girls today including teenage pregnancy, gender based-violence, transmission of HIV from mother-to-child, and sex work.

“The work done by the Taskforce will help us identify gaps and challenges which will enable us to develop more effective intervention programmes,” said the Deputy Minister of the Department of Women, Children and People with Disabilities, Ms Hendrietta Bopane-Zulu.

The members of the Taskforce met with South Africa’s high-level government officials, representatives of international and civil society organisations, parliamentarians and other stakeholders working on the HIV response. The delegation also held discussion with networks of women living with HIV and lesbian, gay, bisexual transgender, and intersex (LGBTI) communities.

High teenage pregnancy

Despite South Africa’s progress in the AIDS response, women and girls remain disproportionately affected by the epidemic. According to the 2008 Human Sciences Research Council (HSRC) household survey, HIV prevalence was more than four times higher in women aged 20–24 (21.1%) than in men in the same age group (5.1%).

Social determinants such as poverty, inequalities, gender based violence, and limited access to sexual and reproductive health information together with a lack of adolescent friendly health services make teenage girls vulnerable to unintended pregnancy and HIV infection. Data from the National Strategic Plan on HIV, TB and STIs, 2012–2016 shows that 39% of 15–19-year-old girls have been pregnant at least once and 49% of adolescent mothers are pregnant again in the subsequent 24 months. It also reveals that one in five pregnant adolescents is HIV-positive.

“We are doing everything possible to end teenage pregnancies, which are primarily caused by older men taking advantage of young girls,” said South Africa’s Deputy President Kgalema Motlanthe. “We have all the necessary policies in place but our biggest challenge is changing societal attitudes,” added Dr Motlanthe.

The Taskforce team engaged with the King Goodwill Zwelithini of KwaZulu-Natal Province regarding traditional and social norms, such as intergenerational sex and  multiple and concurrent partnerships that contribute towards the issue of teenage pregnancy. "We should not only focus on youth programmes,” said King Zwelithini. “We must also educate parents at home because some parents find it hard to talk to their children. It is not easy but we should speak the truth, because the love of truth is the spirit of men," he added.

“Prevention of unintended pregnancies and HIV infection in young girls must be a major priority for South Africa’s leadership”, said Professor Sheila Tlou, Regional Director of UNAIDS and a member of the Taskforce. “Keeping girls in school is critical to reduce new HIV infections among girls and help them to reach their potential.”

Stopping new HIV infections among children

The elimination of new HIV infection among children and keeping their mothers alive was also present during the discussions that the Taskforce members had with South Africa’s Minister of Health, Dr Aaron Motsoaledi. South Africa has seen a decrease in mother-to-child transmission of HIV from 3.5% in 2010 to 2.7% in 2011 and is well on its way to meet the target set in the 2011 Political Declaration on HIV/AIDS of virtual elimination by 2015.

Minister of Gender, Children and Social Development in Kenya and member of the Taskforce, Naomi Shaban (left) with South Africa’s Deputy President Kgalema Motlanthe.

While acknowledging the drop in new HIV infections among children, the Minister of Gender, Children and Social Development in Kenya, Dr Naomi Shaban—who led the Taskforce delegation—stressed that more needs to be done to keep mothers alive. “We need to redouble our efforts to save babies but also, we need to ensure that the mothers are there to care for their children,” said Dr Shaban.

In order to address the high rates of maternal mortality in South Africa—310/100 000 live births—earlier this year, the National Department of Health, spearheaded by the Minister of Health, Dr Motsoaledi, launched the Campaign for Accelerated Reduction of Maternal Mortality in Africa (CARMMA) in South Africa.

Some of the key elements of CARMMA is to strengthen women’s access to comprehensive sexual and reproductive health services, especially family planning to prevent new HIV infections and unintended pregnancies, strengthen the health system to provide human resources for maternal and child health and to intensify the management of HIV-positive mothers.

The High-Level Taskforce for Women, Girls, Gender Equality and HIV in Eastern and Southern Africa, which comprises ministers, National AIDS Council (NAC) directors, four regional UN directors, civil society and women living with HIV, was officially launched in December 2011 at the 16^th International Conference on AIDS and STIs in Africa (ICASA). It aims to engage in high-level political advocacy in support of accelerated country actions and monitoring the implementation of the draft Windhoek Declaration for Women, Girls, Gender Equality and HIV.

CARMMA aims to accelerate the implementation of activities to stem maternal and child mortality.

The distinctive cry of a new-born baby pierces the air in the labour ward and stops conversation in its tracks. "That’s what we want to hear" remarks Sister Mavimbela, who just hours ago delivered him into the world. “When a baby cries, that’s the sign of a healthy delivery,” she says with the quiet confidence of someone who knows.

Unfortunately, it is not a cry that is heard every time as South Africa struggles with a high rate of maternal and child mortality. The country has a maternal mortality ratio of 310 deaths per 100 000 live births and an under-five mortality rate of 56 deaths per 1 000 live births.  To reduce this, the campaign on Accelerated Reduction of Maternal Mortality in Africa (CARMMA) was launched at Osindisweni Hospital in Ethekwini District, KwaZulu-Natal Province on Friday 4 May.

CARMMA aims to accelerate the implementation of activities to stem maternal and child mortality and meet Africa’s targets for Millennium Development Goals four and five—to reduce by three quarters the maternal mortality rate and to reduce by two thirds the child mortality rate between 1990 and 2015.

Health care workers at Osindisweni Hospital are certain about what is needed to help achieve these targets: reduce the burden of HIV. They are supported by the numbers.  South African data shows that 50% of maternal deaths and 40% of under-five deaths are as a result of HIV infection.

“We didn’t experience problems like this when I started”, says Sister Phumzile Kwitshana, who has been practicing as a midwife for 24 years. “It has gotten worse because of HIV—now mothers are sick.”

Dr. Amina Kajee, a doctor in the maternity ward at Osindisweni agrees.  “The last two cases of maternal deaths under my care were due to clinically advanced HIV. In one case one of the twins survived, the other didn’t. She only weighed 900 grams.”

The policy framework already exists: offer every pregnant woman HIV testing and counselling under the auspices of the national prevention of mother-to-child (PMTCT) programme. If she tests positive for HIV initiate her onto a regime of highly active anti-retroviral therapy to avoid transmitting the virus to her baby and ensure she is offered a continuum of treatment, care and support for herself and her infant.

However, one of the major obstacles to rolling out the policy successfully is that women often present for antenatal care too late in pregnancy for them to be offered the appropriate care. The overriding factor to explain this seems to be fear or lack of information, or a mixture of both.

“Women either don’t know or don’t want to know,” is how Dr. Kagee explains it.

“Women don’t come to the clinic because they don’t want to disclose to their families or partners… Sometimes it is the attitude of health care workers with the young ones,” says Sister Kwitshana, referring to the disapproval that often meets a teenage mother, sometimes discouraging her from returning. “Some of them just hide their pregnancies until late.”

Health care workers cite other challenges—some seemingly minor administrative issues, such as the need for a dedicated ambulance on standby for maternity cases, so that women at risk can get to hospital before the crisis deepens. In resource poor settings, however, minor challenges easily become major obstacles. These are further compounded by substantial health system challenges. For example, more midwives are needed to address understaffing and they require ongoing training and values clarification.

Nevertheless, the conversation returns to the issue of women themselves. “We need to shake up the community” says Sister Kwitshana.

Community mobilization campaigns are needed to encourage women to present early for antenatal care. Communities should be the bearers of information to prevent unintended pregnancies, especially among HIV positive women and teenagers, and to reduce HIV stigma.

The launch was led by South Africa’s Minister of Health, Dr Aaron Motsoaledi and was attended by a number of dignitaries and celebrities, including the Minister of Women, Children and People with Disabilities, Ms Lulama Xingwana, Advocate Bience Gawanas, the African Union Commissioner for Social Affairs, the Premier of KwaZulu-Natal, Dr Zweli Mkhize, musical icon and UNICEF Goodwill Ambassador, Yvonne Chaka Chaka, Mrs Graça Machel  and UNAIDS Regional Director of the Regional Support Team for Eastern and Southern Africa, Professor Sheila Tlou.

“The launch was a stark reminder of the hard work we need to do to achieve the third target of the Political Declaration on HIV/AIDS: Eliminate new HIV infections among children by 2015 and reduce maternal deaths,” says Professor Tlou. “One death is a death too many.”

Credit: UNAIDS

On World AIDS Day, 1 December 2011, the President of the Republic of South Africa, President Jacob Zuma, officially launched the new South African National Strategic Plan (NSP) on HIV, STIs and TB, 2012–2016.

To frame the NSP, the South African government has adopted UNAIDS vision of ‘zero new HIV infections, zero discrimination and zero AIDS-related deaths’. South Africa however, has added a fourth zero to the plan: ‘zero new infections due to mother-to-child transmission’.

“The addition of the fourth zero shows South Africa’s commitment towards the elimination of new HIV infections among children,” said UNAIDS Country Coordinator Dr. Catherine Sozi. “South Africa has already seen a 50% reduction in mother-to-child HIV transmission between 2008 and 2010. With the prioritization of preventing new HIV infections among children in the new NSP, we are confident that a new generation free of HIV is in our sight,” she added.

The NSP is the product of a long consultative process which the South African National AIDS Council (SANAC) held with the relevant government line ministries, civil society sectors and the private sector. As President Jacob Zuma remarked in his speech on World AIDS Day, the NSP “belongs to all South Africans and all sectors”. 

It also takes into account the bold targets set at the High-Level Meeting on AIDS that took place in New York in June 2011. The new plan denotes the country’s seriousness in honouring the commitments made by adopting the ‘Political Declaration on HIV/AIDS: Intensifying our Efforts to Eliminate HIV/AIDS’ at the High-Level Meeting.

In total there are five overarching goals of the NSP: to halve the number of new HIV infections; ensure that at least 80% of people who are eligible for treatment for HIV are receiving it (at least 70% should be alive and still on treatment after five years); halve the number of new TB infections and deaths from TB; ensure that the rights of people living with HIV are protected; and halve stigma related to HIV and TB.

It is the first time that the national plan includes tuberculosis in its goals and strategic objectives. This is due to the high co-infection of HIV and TB in the country, estimated to be approximately 70% in people living with HIV and/or TB. South Africa has the third highest TB incidence in the world, following only China and India.

National stakeholders agreed that in order to achieve the bold targets outlined in the plan there is a need to scale up resources even amidst the current global economic crisis. Owning the resources to fund the plan was seen as key to an effective HIV response. In 2010, South Africa funded almost two-thirds of its own response and committed more than $1 billion to it. For the current plan, alternative sources of funding are being explored such as applying a tax to financial transactions.