As world Leaders joined in Berlin, Germany on Thursday 27 September to announce their financial pledges to the Global Fund to Fight AIDS, Tuberculosis, and Malaria for the next three years, UNAIDS Executive Director Peter Piot underlined the United Nations commitment to “make the money work – to help make Global Fund grants as effective and beneficial as possible on the ground.”

“UNAIDS is an important partner to the Global Fund, providing essential support for its work,” he said.

In his statement to the participants of the Global Fund’s replenishment conference, taking place in Berlin, Dr Piot emphasized the urgent need for an adequately funded large-scale AIDS response now, in order to avoid even higher costs in the future.

“There are so many challenges facing the developing world that some may ask why fighting HIV is a priority,” he said.  “The answer is threefold – the cost in lives lost has been tremendous, the cost of saving lives will only increase as time goes on without an adequate response, and, finally, responding to AIDS is essential in order to address every other development issue worldwide.”

“The United Nations’ technical expertise, its experience coordinating with countries, and its understanding of working with civil society are key contributors to the work of the Global Fund,” he added.

Dr Piot’s intervention came during the pledging session, where the head of each delegation addressed donors prior to their pledge announcements.

Merkel: ‘Prioritize health, increase coordination’

Opening the day’s events, German Chancellor Angela Merkel spoke in front of an audience of heads of country delegations from around the world, including the United States, United Kingdom, Russian Federation, Australia and the European Commission. Also present were delegates from multilateral organizations, including UNAIDS and the World Health Organization, as well as donors such as (PRODUCT) RED.

In her remarks, Chancellor Merkel urged countries around the world to prioritize tackling the global HIV, tuberculosis, and malaria pandemics. She placed particular emphasis on the need for to increase coordination between bilateral and multilateral programmes, and expressed satisfaction about efforts such as the International Health Partnership, in which UNAIDS is a partner, launched on September 5 in London.

Merkel also called on business leaders in Germany and other countries to establish a new tradition of philanthropy in order to contribute to the Global Fund and other international health efforts. To that end, representatives from leading German businesses met on Wednesday with Global Fund Replenishment Chair Kofi Annan to discuss novel approaches to supporting global health programmes, including the Global Fund.

Other speakers at the opening meeting were Global Fund Executive Director Michel Kazatchkine, Board Chair Rajat Gupta and Vice Chair Elizabeth Makata, and German Development Minister Heidemarie Wieczorek-Zeul. The event was opened by former United Nations Secretary-General and Replenishment Chair Kofi Annan. In his statement, Annan praised the record of the Global Fund, saying that after five years, “we have a fund that is highly successful in spending money to save lives” and that “money channeled through the Global Fund is money invested effectively.”

Since its founding in 2002, more than 60 governments, private foundations, corporations and individuals have contributed more than US$ 11 billion to support the Global Fund. The Global Fund's total funding need for 2008-2010 is US$ 12-18 billion, necessary to support existing grants and fund critical new programmes to fight AIDS, tuberculosis and malaria. Delegates are gathering in Berlin from 26-28 September for the second round of the Global Fund’s biennial meetings to raise funds for its programmes to provide essential HIV, tuberculosis and malaria services in developing countries.

The report* puts forward three
different approaches to financing
the AIDS response

UNAIDS has released a new report on the estimated financial resources required for the AIDS response. The report, entitled Financial Resources required to Achieve Universal Access to HIV, Prevention, Treatment, Care and Support* puts forward three different approaches to financing the AIDS response including:

Scaling-up at current rates. By following the current rate of annual scale-up, the estimated resource requirements would be between US$ 14 - 18 billion in 2015, this amount would provide antiretroviral treatment for 8 million people in that year and the prevention, care, support and social mitigation targets would be far from Universal Access levels.

Universal Access by 2010. This approach envisages significant increases in available resources and an urgent and dramatic scale-up of coverage in all countries.  Following this approach would provide antiretroviral treatment for 14 million people by 2010. To achieve this, the annual resource requirements would rise to between US$ 32 - 51 billion in 2010 and between US$ 45 - 63 billion by 2015. Prevention, care, support and social mitigation targets would also reach the targets consistent with universal access in 2010.

Phased scale-up to universal access by 2015. This approach assumes different rates of scale-up for each country based on current service coverage and capacity, with the achievement of different programmatic targets (prevention, care, treatment, support and social mitigation) at different times and the achievement of universal access by all countries by 2015.  The approach would require between US$ 41 - 58 billion in 2015.

The estimates provided in the report, developed for 132 low- and middle-income countries, were based on the type of epidemic and nationally established targets using the latest available data.

Delegates from donor countries and international organizations gathered in Berlin on Wednesday 26 September to begin the second of the Global Fund’s biennial meetings to raise funds for its programmes to provide essential HIV, tuberculosis and malaria services in developing countries. The meeting, which runs through to Thursday 28 is being attended by a delegation from UNAIDS led by Executive Director Dr Peter Piot. The meeting will be chaired by former UN Secretary-General Kofi Annan and co-chaired by Sven Sandström, former Managing Director of the World Bank. German Chancellor Angela Merkel will make remarks at the opening of the official portion of the meeting on Thursday, in which donor countries will pledge to make contributions for the Global Fund’s operations for the next three years.

In the lead-up to the pledges, a number of related events took place on Wednesday 26 including the launch of a new initiative based around debt-relief called "Debt2Health". The initiative uses debt conversion as a mechanism whereby a creditor or a group of creditors agrees to cancel a portion of a country's debt on the condition that the beneficiary invests an agreed-upon amount in a Global Fund-approved programme. The German government made the first offer to forgo repayment of 50 million Euros on the condition that Indonesia invests the equivalent of 25 million Euros in health through approved Global Fund programmess.

In addition, members of civil society came together with meeting participants to discuss their evolving relationship, and representatives from major health and human rights organizations discussed the scale-up of gender sensitive responses in health programmes.

Since its founding in 2002, more than 60 governments, private foundations, corporationsand individuals have contributed more than US$ 11 billion to support the Global Fund toFight AIDS, Tuberculosis and Malaria. The Global Fund's total funding need for 2008-2010 is US$ 12-18 billion. This money will be used to support existing grants and also to fund new ones to fight AIDS, tuberculosis and malaria.

The estimates provided in the Financial Resources required to Achieve Universal Access to HIV, Prevention, Treatment, Care and Support report, developed for 132 low- and middle-income countries, are based on the type of epidemic and nationally established targets using the latest available data.

The data was reviewed by Technical Working Groups and by an advisory board made up of international economists and AIDS experts from donor and developing countries, civil society, United Nations agencies and other international organizations.

Methodological Annex - I
Integrating the prevention of violence against women and PEP into the HIV Programmes: preliminary framework and proposed next steps
Download full text

Methodological Annex - II
Revised Projections of the Number of People in Need of ART
Download full text

Methodological Annex - III
Methodology for Care and Treatment Interventions
Download full text

Methodological Annex - IV
Description of Interventions/Services Included in the Estimates of Resources Needed for HIV and AIDS
Download full text

Methodological Annex - V
Research & Development for new prevention technologies
Download full text

Methodological Annex - VI
UNAIDS Consultation on Global Resource Needs Estimates (GRNE) to achieve Universal Access to HIV and AIDS Services and the Millennium Development Goals, 2009-2015 (1 - 2 May 2007)
Download full text

Methodological Annex - VII
UNAIDS Consultation on Global Resource Needs Estimates (GRNE) to achieve Universal Access to HIV and AIDS Services and the Millennium Development Goals, 2009-2015 (3 - 4 May 2007)
Download full text

Methodological Annex - VIII
An Analysis of the Incremental Programme Costs: General Methodology and Assumptions
Download full text

Methodological Annex - IX
Guidance on cost estimates for IDU interventions
Download full text

Methodological Annex - X
Resource Needs Estimation Process: background
Download full text

Methodological Annex - XI
Estimating the cost of training and retaining field health workers
Download full text

Dr. César Antonio Núñez, UNAIDS
Regional Director for Latin
America, underlined the
importance of the spending
assessment tool for generating
strategic information for decision
making.

Understanding the magnitude of spending on AIDS programmes, the sources of such funding, and the activities supported by such expenditures is critically important to policymakers, programme planners, and international donors. Effective resource monitoring helps identify gaps in the response, improves the strategic ability of countries and donors to target resources most effectively, and helps measure the degree to which words of commitment on AIDS are matched by financial resources.

Working towards better tracking of AIDS spending in countries in Latin America, more than 50 representatives from the region joined in Panama for a specialist workshop designed to underline changes in the technical classification process for tracking AIDS spending and help countries make better use of the UNAIDS-designed National AIDS Spending Assessment (NASA) tool for their analysis.

Organized by UNAIDS, through its Regional Support Team for Latin America and the International Center for Technical Cooperation on AIDS (ICTC), the workshop also served as a platform for discussing challenges and problems faced by countries when implementing the spending assessments.

NASA is a methodology that identifies financing flows directed to HIV prevention and health care for AIDS. It also identifies funds directed to activities on education, social development and social security that are related to AIDS. The information provided through NASA helps identify how funds are being channeled to different groups of people and geographically which assists with the development of National Strategic Plans and advocacy actions.

Dr. César Antonio Núñez, UNAIDS Regional Director for Latin America, underlined the importance of the spending assessment tool for generating strategic information for decision making. “This is critical for countries to identify if the spending of their resources, both national and external, is undertaken in populations and areas recognized as priorities,” he said.

Carlos Passarelli, ICTC Director, emphasized that “the Centre supports this joint effort of countries in improving their capacities on planning and administration of resources because this is key for the sustainability of AIDS responses in the region”.

Over the last year, UNITAID has
committed a total of US$ 45 million
for second-line antiretroviral drugs
to fund the treatment of 65 000
patients by 2008.

One year on since its establishment, the international drug purchase facility – UNITAID – is celebrating a number of key achievements.

“In the year since it was established, UNITAID has managed to reduce the price of HIV treatments for children by almost 40%, and those for second-line antiretroviral (ARV) drugs by between 25% and 50%,” UNITAID reported.

“In collaboration with the Clinton Foundation, UNITAID has also delivered more than 33 000 paediatric treatments against AIDS and is on course to meet the needs of 100 000 children by the end of 2007.

”UNITAID was launched in September 2006 during the United Nations General Assembly. The mandate of UNITAID is to contribute to the scaling up of access to treatments for AIDS, malaria and tuberculosis in developing countries by leveraging quality drugs and diagnostics price reductions and accelerating the pace at which these are made available. UNITAID offers beneficiary countries long-term support through sustainable and predictable funding, mobilized by innovative financing mechanisms, such as a solidarity contribution on air tickets, together with multi-year predictable budgetary contributions.

Over the last year, UNITAID has committed a total of US$ 45 million for second-line antiretroviral drugs to fund the treatment of 65 000 patients by 2008. “Four countries (Botswana, Cameroon, Uganda and Zambia) have already received a first supply of second-line ARV drugs through UNITAID and a further 13 countries are currently awaiting delivery,” said UNITAID.

UNITAID is also contributing to the fight against tuberculosis together with the Global Drug Facility and the Stop TB Partnership. By the end of the year, UNITAID will have provided TB treatments to 150 000 children in 19 countries and will be supporting the provision of drugs for Multidrug - resistant TB in 17 low-income countries.

For each programme, UNITAID sets up an ad hoc partnership with existing organizations: World Health Organization, UNICEF, the Global Fund to Fight AIDS, Tuberculosis and Malaria, the Clinton Foundation, Global Drug Facility/Green Light Committee and the Stop TB Partnership.

”UNITAID is a prime example of the rapid, flexible and innovative action needed to develop a sustainable long-term response to AIDS and reach universal access to HIV prevention, treatment, care and support,” said UNAIDS Deputy Executive Director, Michel Sidibe. “In less than a year, UNITAID has shown that harmonization, simplification and coordination lead to less duplication and much more effective use of resources. It is a real model of ‘making the money work’ and scaling up of existing programmes for the benefit of the people who need it most.

Based in Geneva, the UNITAID Trust Fund and Secretariat are hosted by WHO. At present, 27 countries— of which 19 are in Africa— are members and contribute to UNITAID. At least 85% of UNITAID funds are spent in low income countries. The budget of UNITAID for 2007 is over US$ 300 million and 90% has already been committed to programmes in more than 80 countries.

CHAT helps map stakeholders in
countries and assess the strengths
and weaknesses of their engagement
with the national AIDS response.

With increased funding and technical support resources available for AIDS, the need for coordinated, harmonized and aligned national AIDS responses has never been greater. To help countries ensure inclusive, participatory national responses to AIDS, UNAIDS with the World Bank has developed the ‘Country Harmonization and Alignment Tool' (CHAT) to help map stakeholders in countries and assess the strengths and weaknesses of their engagement with the national AIDS response. Team Leader in the Aid Effectiveness Division, Desmond Whyms, explains how the tool can help move AIDS responses forward and lead to positive action for change.

What is CHAT?

Many countries now face the challenge of having considerable amounts of money and technical support for AIDS available, but often lack strong coordination for those resources to ensure a common focus among the wide variety of national partners and international partners. CHAT aims to inspire a more inclusive national response through a survey process which first maps the various stakeholders involved in the national response and then through structured interviews with national and international partners establishes how well the national partners are engaged and how harmonized the international players are. This systematic information gathering and analysis helps to put together a picture at country level of the quality of the partnerships in the AIDS response, which then catalyses a dialogue on the strengths and weaknesses, and can help countries move forward in a more harmonized way.

How should countries use CHAT?

Every country’s AIDS coordinating authority should be doing a regular review of progress and performance, and the CHAT is designed to be a part of that process. It is also possible to use CHAT as a free standing tool if a country wants to have a more immediate overview of the quality of the national and international engagement in the national AIDS plan.

What are the necessary steps to put the tool into practice?

CHAT has been piloted in several countries in 2006. In many of the pilot countries, the administration and analysis has been done by a consultant, on behalf of the national AIDS authority. It is designed as a light process that is not burdensome for staff in the national AIDS authority. The consultant administers the appropriate questionnaires—one for national and one for international partners, and then collates and analyses the data to produce a draft report. The CHAT contains guidance on how to do this.

CHAT covers the range of areas in which the
national and international partners should be
engaged with the AIDS response at the country
level.

Can you give an example of some of the areas covered in the questionnaire?

CHAT covers the range of areas in which the national and international partners should be engaged with the AIDS response at the country level like strategy development, resource allocation, administration and monitoring procedures. The questions are based on what is best practice and what’s been promised by international institutions’ headquarters, following their commitments to the Paris Declaration, the Three Ones and the Global Task Team for example. By the very fact of starting to ask these questions at the country level we are starting to put pressure to move in this direction, and that we need to improve the way we work and the way we are engaging to achieve results.

The questionnaires are in the format of self reporting, for example: does your organization participate in decision making about the allocation of resources within the national AIDS budget? For many of the national partners we’ve contacted in the pilot countries, this is the first time anyone had ever really asked them these questions. The feedback has been that this exercise is empowering as all voices are being listened to.

What happens at the end of the questionnaire and analysis?

The output is an analytical report which is intended to feed into the discussions in the context of the joint AIDS review. Most of the international community has already signed up to the principles of good practice and the challenge of the CHAT is to see if those principles are being applied in a particular country to the AIDS response. This is the only tool that exists that allows us to explore this, the intention being that it will flag areas for improvement that can then be addressed through the AIDS review at national level. We can also bring the findings back to headquarters for a comparative analysis, and look at the patterns across the regions.

What are the benefits for the countries?

Most people know the quantity of the response within countries and they should know how much money is being brought by the different partners but what is less known is how well it is all adding up together and pulling in the same direction. This is a low-maintenance tool that really allows countries to start taking stock of the quality of the AIDS response in their countries in terms of harmonization and alignment between national and international partners. It will help us start making sure that we really are “making the money work” and moving towards Universal Access.

Dr Piot noted the leadership role that
has been played by the United States
in addressing the global AIDS
epidemic. Photo credit: H. Fancher

UNAIDS Executive Director Peter Piot participated in a forum at the Woodrow Wilson International Center for Scholars in Washington, D.C., discussing the United States’ important role in the global AIDS response and the upcoming reauthorization of the U.S. President’s Emergency Plan for AIDS Relief. U.S. Representative Nita M. Lowey and Kent R. Hill of the U.S. Agency for International Development also spoke at the forum.

During his speech, Dr Piot noted the leadership role that has been played by the United States in addressing the global AIDS epidemic, and called on the country to maintain and strengthen this commitment. “We must accelerate our efforts, and broaden them—by bolstering our long-term, sustainable efforts to fight this disease,” he said. “For the United States in particular, that means sustaining the leadership role you have played in recent years. Your investments have had powerful results for many people around the world. We need your leadership to continue – and intensify – on all fronts.”

The UNAIDS Executive Director is in the United States to speak with leaders from government and civil society about the state of the global AIDS epidemic and role U.S. organizations can play in the response. On Tuesday 18 September he addressed students and faculty at Washington D.C.’s Howard University. Next week he will give the keynote speech at a symposium on children and AIDS at Harvard University Medical School.

Howard University’s hospital was the first in the
United States to routinely offer HIV testing to all
patients.

The important role of academic organizations in the global AIDS response was underlined on Tuesday 18 September in a special lecture given at Washington D.C.’s Howard University by UNAIDS Executive Director Dr Peter Piot.

Addressing students, faculty, community members and journalists, Dr Piot praised Howard University for its commitment to confronting HIV in Washington, D.C. – one of the areas most affected by AIDS in the United States, with approximately one in twenty of the city’s residents living with HIV.

“This university has done so much to raise awareness to unmet needs at every level of society – and you have been a great partner in the global fight against AIDS. Faculty and students at Howard are addressing HIV on multiple fronts as scholars, scientists and activists,” said Dr Piot. “The world must follow your example. That is the only way we will ever get ahead of this epidemic,” he added.

Howard University’s hospital was the first in the United States to routinely offer HIV testing to all patients; its law students run a legal clinic for people living with HIV; and the university recently convened a conference on the global AIDS response.

In his speech, sponsored by the National Minority AIDS Council, D.C.-based AIDS service organization the Women’s Collective, and Howard’s Student Health Center and Women’s Health Institute, the UNAIDS Executive Director also highlighted the important role of the United States in funding the global AIDS response.

“PEPFAR [the United States’ President’s Emergency Plan for AIDS Relief] enabled us to make a quantum leap forward against AIDS,” Dr Piot said. “With PEPFAR, the global discussion about responding to AIDS stopped being about ‘millions’ and started being about ‘billions.’ PEPFAR runs out next year, giving the United States a unique opportunity to continue its support of a truly global effort.

”Later this week, Dr. Piot will speak at the Woodrow Wilson Center for International Scholars in Washington. He will also travel to Boston to give the keynote speech at a symposium at Harvard University Medical School on children and AIDS.

Experience and evidence show that for an effective response to AIDS, it is essential to involve people living with HIV at all levels. Networks of people living with HIV are uniquely well qualified to help unify the response and maximize efforts to reach out to communities as well as influence national policy.

UNAIDS has produced a new report that describes
the background, structure and operation of the All-Ukrainian Network of People Living with HIV, as an example of best practice within the AIDS response.

In order to promote and help replicate the work of associations of people living with HIV, UNAIDS has produced a new report that describes the background, structure and operation of the All-Ukrainian Network of People Living with HIV, as an example of best practice within the AIDS response.

“The All-Ukrainian Network of People Living with HIV has an innovative structure, has undertaken high profile successful advocacy campaigns at both national and local levels and has a strong track record of delivering an ever-expanding array of services to people living with HIV,” the report says. “From the outset, people living with HIV have been responsible for the Network’s very rapid growth and strategic importance in the country’s HIV response.

”Ukraine has the most severe HIV epidemic in Europe, with an estimated 377 600 people living with the virus at the end of 2005. The Network was formed in the late 1990s by people living with HIV alarmed by the rapidly growing HIV epidemic in the country and the lack of resources and support available to them and others living with the virus. Since then, the Network has grown rapidly and steadily from its registration in 2000 to its designation as a co-Principal Recipient of a Global Fund grant to distribute funds for treatment, care and support. In 2006, it provided services and support to more than 14000 people living with HIV.

At the national level, the
Network’s advocacy efforts have
resulted in a number of high
profile achievements in recent
years.

The Network was established under four key strategy components: increasing access to non-medical care, treatment and support; lobbying and advocating to protect the rights of people living with HIV; increasing acceptance towards people living with HIV throughout society; and enhancing the organizational capacity of the Network.

Through its local branches and affiliated organizations, the Network provides services to thousands of people living with HIV across Ukraine. It also works with ‘indirect clients’, such as injecting drug users, health-care workers, journalists and law enforcement officials, as part of a broader effort to increase social tolerance, raise awareness about HIV transmission prevention and reduce stigma and discrimination.

More than 20 distinct types of services are offered around the country ranging from transportation and nutrition support to treatment literacy training and child-care facilities. Some local groups may even provide a teacher in instances when real or perceived discrimination keeps HIV-positive children out of public schools.

At the national level, the Network’s advocacy efforts have resulted in a number of high profile achievements in recent years, notably a series of meetings with the Ukrainian President in November 2005, where he committed to take personal control of the government’s response to the epidemic. Furthermore, recent advocacy and awareness-raising efforts at national level include continuing efforts to push the government to increase antiretroviral treatment and HIV testing availability through the public sector; working with the media to publicize issues such as poor service delivery; delays within the Ministry of Health; the high price of antiretroviral drugs; and corruption within the procurement and tendering processes.

Local branches of the Network also initiate smaller-scale advocacy efforts that relate to their local needs.

Local branches of the Network also initiate smaller-scale advocacy efforts that relate to their local needs. For example, one group successfully filed and won a court case defending the rights of HIV-positive parents to maintain custody of their children. In August 2006, another group successfully advocated for the provision of antiretroviral treatment in local prisons. Within two months, five inmates were on treatment and two prisons now also have the capacity to provide CD4 testing.

The Network seeks to form partnerships with as many stakeholders as possible. It currently works with government agencies, international organizations, donor agencies and domestic NGOs. “Although often there are strategic and procedural differences with some of the partners, the Network has refused to break ties even as it lobbies, privately and publicly, for policy change,” the report states.

The Network’s collaboration with international organizations, bilateral donors and civil society groups has consisted of financial support, technical assistance, advocacy collaboration and policy development at local, national and international levels. Although initially the Network was mainly the recipient of the assistance, as it has developed, it has played a growing role in identifying ways to share its expertise and experience.

Underlining the Network’s importance as an example of best practice, UNAIDS Partnerships Advisor Kate Thomson said: “This is a role model for positive networks the world over and provides us with a truly inspiring example of positive people coming together to make a difference in the AIDS response.”