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Africa: Funding Slowdowns Hit AIDS Programs

AfricaFocus Bulletin
Mar 1, 2012 (120301)
(Reposted from sources cited below)

Editor's Note

In the last 15 years, AIDS activists and medical professionals, in Africa and around the world, have won the recognition that the fight against AIDS, which disproportionately affects the African continent, is a shared global responsibility.

Millions of lives have been saved. But the fight against AIDS and the wider commitment to health as a universal human right is now threatened by "AIDS fatigue" and austerity politics. It's time to build on success and reject the callous assumption that millions more should simply be left to die, whether from AIDS or as a result of other unmet health needs.

Long-time readers of AfricaFocus will be aware that HIV/AIDS and the right to health have been regularly featured in AfricaFocus Bulletins, not only because of their intrinsic importance but because this issue has been an indicator of global willingness to take on its share of responsibilities in confronting global crises which disproportionately affect the African continent.

Spearheaded by groups such as the Treatment Action Campaign in South Africa, joined by international groups, the international AIDS conference in Durban in 2000 marked a launching point for attacking the assumption that African lives did not count. Practical and institutional changes since then have been enormous. The Global Fund to Fight AIDS, TB, and Malaria was created. The Bush administration, in which the AID director in 2001 offered the view that AIDS treatment for Africa was useless because "they don't know what Western time is" (, was forced to shift course, launching a bilateral AIDS initiative (PEPFAR). The South African government eventually moved from denial to taking the global lead in responding to AIDS (

Yet today, except for those on the front lines of the fight against AIDS, there is a tendency to regard the issue as solved, or at least of lesser priority.

With the 19th International AIDS Conference scheduled for July this year in Washington, DC, activists will be mobilizing to call for renewed action. As a modest contribution to these efforts, AfricaFocus is adding a new "Featured Issue Focus" on the home page ( Readers are encouraged to use this and to pass it on to their colleagues, friends, and students. Included are links to "Ten Talking Points" (, "Key Groups & Agencies" (, "Key News & Issue Links" (, and, for those interested in exploring the history of the issue, a full archive of relevant AfricaFocus Bulletins (

Your feedback and suggestions of material for future AfricaFocus Bulletins or for this Featured Issue Focus are welcome.

Today's AfricaFocus Bulletin contains (1) a report on the partial release of delayed funds to Global Fund recipients in South Africa, including the Treatment Action Campaign, (2) a report on progress, and rising costs, in South Africa's national strategy to fight AIDS, and (3) excerpts from a report by the International HIV/AIDS Alliance from a survey of its affiliates on the current and potential impact of the global slowdown in AIDS funding growth. Countries surveyed in more detail in the Alliance report included South Sudan, Zambia, and Zimbabwe.

Additional recent related reports of interest include:

Center for Strategic and International Studies, "Righting the Global Fund," Feb. 27, 2012

Global Fund Observer, "Demonstrators Rally to Urge African Leaders to Spend More on Health," Jan 24, 2012

Inter Press Service, "Burkina Faso: More Money Needed to Guarantee Availability of ARVs," Feb. 14, 2012

Kaiser Family Foundation, "Budget Tracker: Status of U.S. Funding for Key Global Health Accounts," Feb. 15, 2012

Update on Senegal:

The first round of election concluded without a winner, and a second round vote will be held this month. President Wade received 34,82% of the votes cast, and the leading opposition candidate Macky Sall received 26,57%. Complete provisional results are available at National and international observers agreed that the polling itself was orderly and remarkably free of questionable incidents.

Additional sites of interest, in addition to those cited last week, include,,, and

++++++++++++++++++++++end editor's note+++++++++++++++++

South Africa: Global Fund Monies Finally Released

22 February 2012


[This report does not necessarily reflect the views of the United Nations ] /

[For additional background on the delays in disbursement of Global Fund grants in South Africa, see Global Fund Observer, Issue 176: 20 February 2012 / direct link: 176&article=1]

Cape Town - More than seven months overdue, the Global Fund to fight AIDS, Tuberculosis and Malaria grant will finally be released to key South African AIDS organizations that have been struggling to survive. Some were on the verge of shutting down.

The Global Fund released US$7,106,426.91 to the South African National Treasury on 6 February, the same day seven of the grant's sub-recipients delivered an open letter to Minister of Health, Aaron Motsoaledi, pleading for intervention to bring the Fund's "life-threatening delays" to an end.

Signed by the Treatment Action Campaign (TAC) and six other sub-recipients of the Fund's Round 6 HIV grant to South Africa, the letter warned of imminent closure of vital community-response programmes across South Africa, a country with one of the world's highest HIV burdens.

The payment, of which US$2,722,555 will be released this week to the sub-recipients, represents about half the total owed by the Global Fund to these community organizations for July-December 2011. It covers human resources only and no programmatic costs.

Funding crisis

The Fund cancelled its Round 11 funding last November after a funding crisis and allegations of corruption, and early this year executive director, Michel Kazatchkine, resigned. The new general manager, Gabriel Jaramillo, is expected to spearhead a reform process.

The South African sub-recipients of Round 6 funding would like to see some change. "Almost every tranche has been late since the beginning," said TAC treasurer Nathan Geffen. He said that when the July 2011 tranche failed to appear, TAC was initially unsurprised. However, as weeks and then months passed, the situation became untenable.

The blame game

"What has become patently clear is that the Global Fund systems are so complex that neither the Fund nor its principal recipient, the Department of Health, is able to manage the system properly," Geffen told News.

Organizations such as TAC, which deliver services on the ground, are not funded directly by the Global Fund. Instead it contracts with a single principal recipient, the health department, encouraging organizations from different sectors to work together.

If all these programmes were to collapse, there's no doubt in my mind that there would be a negative impact on the reduction in new infections, which is the holy grail of HIV programmes

In theory, this system should simplify administration. But with multiple organizations trying to meet complex reporting requirements, the result appears to have been additional complications that TAC says the health department is not adequately equipped to administer.


According to the Global Fund Observer (an independent newsletter on the Global Fund produced by Aidspan), the situation was further complicated by the South African Country Coordinating Mechanism's (the implementing body for the grants, made up of government and local stakeholder organizations, including TAC) desire to consolidate the Round 6 grant with its Round 9 and new Round 10 funding, all of which would then be managed by the health department.

Thus the department and Fund embarked on implementing a "singe-stream-of-funding" negotiation, a process that took longer than expected and was not finalized until 15 December 2011.

"Yesterday, in a formal meeting, the Global Fund people admitted that the main reason for the delay was the attempt to consolidate the round 6, 9, and 10 grants into a single system," Geffen told News.

The Fund acknowledges that the single stream funding did slow the grant disbursement, but maintains the fault lay with the grantees. "The Single-Stream-of-Funding grant was delayed as the grant documents did not contain information requested by the Global Fund," Fund spokesperson Marcela Rojo told News by email.

Meanwhile, Minister Motsoaledi, who acts as chair of the Country Coordinating Mechanism, told News he was not "very sure" if the funding stream was the reason. "We are looking at what [caused] the delay, and we tried to correct everything that could have been wrong," Motsoaledi said.

David Garmaise, a senior analyst at Aidspan, told News that most people working on Global Fund programmes agreed that single stream funding was preferable, but that in practice, it was not easy to realize. "The Global Fund, as the agency pushing for this change, has a responsibility to ensure that the transition is handled smoothly, and that care, treatment, prevention and other services are not disrupted in the process," Garmaise said.

Under pressure

Regardless of who is at fault, services in South Africa have been disrupted, and the reality on the ground is grim. Nearly all the sub-recipients have dug deep into reserve funds. Furthermore, the ability to plan activities has been hamstrung.

One of the casualties of the delayed funds has been Soul City, an organization that uses mass media for public health. Soul City's HIV prevention radio programme, broadcast in nine languages across the country, has been scrapped for the time being. "It means that we're not reaching poorer, more rural people in their own languages.

There's a whole range of things we're having to do away with," said programme director Sue Goldstein.

Jack Lewis, director of the Community Media Trust (CMT), a fellow Round 6 sub-recipient, is concerned that the ultimate result of the collapse of programmes like Soul City's and CMT's own popular "edu-tainment" offerings, as well as major programmes such as TAC's treatment literacy campaign, will mean reversing gains in reducing new infections and increasing ART adherence.

"If all these programmes were to collapse, there's no doubt in my mind that there would be a negative impact on the reduction in new infections, which is the holy grail of HIV programmes. We'd also see a worsening of adherence. The need to maintain adherence through motivation versus policing is a vital component of these programmes, so you'd expect to see more problems with that, which means more people have to go on second-line treatment, which is more expensive and adds the possibility of the passing on of the resistant virus," Lewis said.

Meanwhile, the sub-recipients still do not know when they can expect the balance owed from 2011, or 2012's first payment. "I don't see any light at the end of the tunnel. After the meeting [with the Global Fund], we are feeling as hopeless as when we entered," said Geffen.

The Fund maintains that now that single stream funding is in place, recipients will see some change. "The Global Fund is working with the [primary recipient] to improve the quality of grant documents so that the disbursement processes can go more smoothly in the future," said Rojo.

South Africa: New reports chart progress - and costs - in HIV fight

IRIN Humanitarian News and Analysis

Johannesburg, 27 February 2012 (PlusNews) - Mothers, babies and newly diagnosed HIV patients are receiving more of the services they need but progress comes at a cost, according to a new report that predicts a funding shortfall for HIV treatment in South Africa.

On 23 February, the Health Systems Trust released the latest versions of its annual District Health Barometer and South African Health Review.

Although in its sixth year of publication, this year's barometer is the first to include data on early infant HIV testing for babies born to HIV-positive mothers and shows that about half of all babies born to HIV-positive mothers are now being tested for the virus at six weeks of age, an important step to ensuring they access the early HIV treatment recommended for all children younger than one under national guidelines. In 2009, only about a quarter of such babies were being tested using the sensitive polymerase chain reaction - tests that confirm whether HIV-exposed infants are HIV-positive.

The report also found that almost all pregnant women are now tested for HIV, which has helped lower mother-to-child HIV transmission to below 4 percent in the country.

The latest barometer is also the first to include data on tuberculosis (TB) screening among newly diagnosed HIV patients. In 2008, only about a third of new HIV patients were screened for TB; in 2011 about 70 percent were checked.

People who have both HIV and carry latent TB are up to 30 times more likely to develop active TB as their HIV-negative peers and TB remains the leading cause of death in South Africa and among people living with HIV worldwide.

Funding shortage

The HST also launched the South African Health Review, an independent review of the public health sector funded by the South African government. While the report notes that HIV/AIDS spending has increased substantially since 2007, it predicts the country will need up to US$5.3 billion extra every year to sustain its HIV/AIDS response, particularly treatment.

The review notes that this year alone the government will spend about $3.1 million on HIV and AIDS; less than a fourth of this comes from donors such as the Global Fund to Fight AIDS, TB and Malaria or the US President's Emergency Plan for AIDS Relief (PEPFAR).

The South African government already shoulders about 80 percent of its HIV treatment costs domestically and authors of the review predict that treatment will be the main driver of the escalating costs of the country's HIV/AIDS response.

In late 2009, the World Health Organization revised its HIV treatment guidelines to recommend that people living with HIV start treatment sooner, at CD4 counts - a measure of the immune system's strength - of 350 or below. Since then, South Africa has gradually fallen into line, first extending earlier treatment to at-risk groups, such as pregnant women and TB patients in 2010 and finally to all patients in 2011. While activists bemoaned the wait, policy-makers argued they had to make sure the country, which shoulders about 80 percent of its treatment costs domestically, could afford it.

As of March 2011, about 1.5 million people were on ARVs in South Africa. The review expects that number to rise to about three million by 2015.

Don't Stop Now: How Underfunding the Global Fund Impacts on the HIV Response

Jan 24, 2012

The International HIV/AIDS Alliance

The International HIV/AIDS Alliance supports communities in developing countries play a full and effective role in the global response to HIV/AIDS. It is a partnership of 37 Linking Organisations (national, independent, locally governed and managed NGOs) around the world that support approximately 2,000 community organisations delivering HIV prevention, treatment and care services to just under 3 million people.

Full report, including country-specific annexes, available at:

A crisis for the Global Fund or a crisis for everyone?

In November 2011, the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund) announced that its next scheduled funding round was cancelled and that no new grants could be funded until 2014. This news hit just as major scientific breakthroughs and signs of real progress in hard-hit countries were starting to generate the most widespread optimism in the history of the AIDS epidemic. Now, all hopes of entering a new phase of the HIV response are effectively put on hold until at least 2014, and progress on many fronts may actually be reversed. The effects on individuals and communities will be devastating.

This report draws on recently collected field data from numerous countries where the International HIV/AIDS Alliance operates to explain why the funding crisis requires urgent action on the part of Global Fund donors and all other stakeholders. The Allianceâ€TMs recommendations for responding to the crisis are based on our analysis of the implications of funding shortfalls in the following specific areas: HIV treatment; HIV prevention; care and support; services for key populations at higher risk of HIV infection; and efforts to create an enabling environment.

Particularly compelling evidence of the need for urgent action comes from in-depth country impact studies in five countries: Bangladesh, Bolivia, South Sudan, Zambia and Zimbabwe. Each of these countries was, until the funding crisis, making strong progress towards reducing HIV infections and AIDSrelated
deaths. The country impact studies document the many ways in which these countriesâ€TM HIV responses are now endangered. For example:

  • In Bangladesh, cancellation of Global Fund Round 11 means that the 20% planned increase in coverage of HIV services for most-at-risk populations will now not be possible; the national response to HIV will effectively stall.
  • The cancellation of Round 11 leaves Bolivia with no means of scaling up HIV prevention services for key populations affected by HIV, including at-risk groups not currently being reached such as prisoners and indigenous people. Therefore an increase in HIV transmission amongst vulnerable populations is expected.
  • In the new Republic of South Sudan, 80% of the national AIDS plan remains unfunded. South Sudan was counting on Round 11 to cover antiretroviral treatment costs and to fund a nascent HIV prevention strategy facing extra stress from returnees from neighbouring countries with high HIV prevalence.
  • In Zimbabwe, an earlier Global Fund grant has funded care and support services in every district, including mobilising clients for HIV testing, positively contributing to treatment adherence, and providing incentives, equipment, and training for caregivers. The funding crisis puts all of these services in jeopardy.
  • In Zambia, where 80% of tuberculosis (TB) patients are HIV-positive, Round 11 funding was seen as critical for strengthening TB/HIV services. Priorities include strengthening intensified TB case finding and TB diagnostic capacity, as well as scaling up isoniazid preventive therapy. Failure to fund these services will threaten hardwon recent progress in reducing HIV-related deaths.

In short, the scale-up of the worldwide HIV response will be seriously affected and important existing services will be reduced or eliminated in the absence of urgent measures. If the global community is to prevent this enormous setback threatening the health and lives of millions of people – and realise the numerous commitments made by United Nations member states through the Millennium Development Goals and at the 2011 High Level Meeting on AIDS – then swift and decisive action is imperative.

For donors and other stakeholders to reduce funding for the HIV response in difficult economic times is short-sighted and counterproductive. While trillions of dollars have been found by governments to bail out the reckless financial sector, donors have left the Global Fund short of the funds it needs to save millions of lives. The Global Fund is the best mechanism the world has for realising the possibility of a world without AIDS but can only do so with sufficient investment.

As we approach the 10th anniversary of the Global Fund, the International HIV/AIDS Alliance urgently calls for donors and national governments to respond to the funding crisis:

  1. Donors must honour existing pledges and increase investment to provide the Global Fund with financing (approximately $2 billion) for a new funding opportunity in 2012.
  2. National governments must increase investment in their own HIV responses and in the implementation of national AIDS strategies that reflect the epidemiology in their countries.
  3. Bilateral donors must take immediate steps to fill critical HIV service gaps that will not be covered by existing funding mechanisms.


AfricaFocus Bulletin is an independent electronic publication providing reposted commentary and analysis on African issues, with a particular focus on U.S. and international policies. AfricaFocus Bulletin is edited by William Minter.

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