G8 Background Policy Brief

March 2012

HIV/AIDS
Please address comments and questions to: John Ruthrauff Director of International Advocacy InterAction jruthrauff@interaction.org 1.202.552.6523 Sue Pleming Senior Director, Communications InterAction spleming@interaction.org 1.202.341.6523 Steven Rocker Senior Advocacy and Research Associate InterAction srocker@interaction.org 1.202.552.6559 Comments and questions on specific recommendations should be addressed to the following individual(s): Craig Moscetti Senior Manager Global Health Council cmoscetti@globalhealth.org 1.202.833.5900

Recognizing the enormous progress of the past thirty years in pursuit of an AIDS-free generation, we urge the U.S. government to support the following recommendations at this years G8 Summit in Camp David:

Detailed Recommendations
1. Reaffirm U.S. commitment to reach its goals of supporting 6 million people on HIV/AIDS treatment (including 1.5 million HIV-positive women); preventing 12 million new infections; and providing care for 12 million people by the end of 2013, as well as U.S. leadership in eliminating pediatric HIV infection by 2015. U.S. policy and action contributing to the goal of universal access by 2015 should be based on a balanced, evidencebased approach, respectful of human rights, and in partnership with civil society. U.S. policy through the guide of supporting increased national ownershipshould emphasize increased implementation of a combination of prevention approaches, integration of HIV/AIDS programming with sexual and reproductive health whenever feasible, and expanded support for innovative outreach to most-at-risk populations (including injecting drug users, men who have sex with men and those who engage in sex work). 2. Fulfill the remainder of the United States three-year, $4 billion pledge to the Global Fund to Fight AIDS, Tuberculosis and Malaria for 2011 through 2013. U.S. leadership is also required to facilitate other G8 countries to fulfill their pledges, as well as to recruit new donors to put the Global Fund back on track. Effective implementation of U.S. global HIV/AIDS programs is based on a synergistic network of infrastructure between the Global Fund and PEPFAR. In addition to U.S. Global Fund dollars being matched two-to-one, U.S. investments in the Global Fund also allow for more effective implementation of its own HIV/AIDS programs. The Obama administration and Congress have continued to demonstrate shared support for the Global Fund, and should consider facilitating the necessary action to improve the Global Funds financial footing, including an emergency donors conference to help close a $2.2 billion gap in outstanding pledges, a primary reason for the Global Fund cancelling its most recent round of funding. We also call on the U.S. to play an active role on the Global Fund Board of Directors to implement recommendations of the High Level Independent Panel on Fiduciary Controls and Oversight Mechanisms.

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Prioritize investments that strengthen health systems and integrate HIV/AIDS into broader health and development strategies to ensure sustained progress. The U.S. should honor commitments made in research, innovation and capacity development, particularly efforts to strengthen national health systems by training 140,000 new health workers, and help facilitate the development and introduction of new preventive, diagnostic, and treatment technologies. The U.S. should continue its targeted efforts to promote program integration through PEPFAR that builds health system capacity with partner countries, specifically areas of health workforce training, research and laboratory development, and innovative service delivery. Investments in basic research and development should remain a priority, including research for sustainable and affordable diagnostics, treatments for HIV and its associated co-infections, and HIV-specific prevention technologies, such as microbicides and vaccine development. Box 1. Latest PEPFAR Result U.S. dollars have achieved the following: HIV/AIDS treatment for more than 3.9 million men, women and children HIV testing and counseling for more than 40 million people in 2011 200,000 infants born HIV-free from prevention of mother-to-child transmission of the disease Care and support for nearly 13 million people and 4.1 orphans and vulnerable children in 2011

exercised bold leadership by taking historic action to help catalyze global action against the mounting HIV/AIDS crisis. Since the launch of PEPFAR in 2003, thanks to strong, bipartisan support, resources for HIV/AIDS exponentially increased. PEPFAR mobilized more than resources but also demonstrated positive health results can be achieved on a considerable scale, all while supporting U.S. national security and foreign policy interests. We applaud the significant results to date and we enthusiastically welcome and strongly endorse the U.S. pledge and policy priority of creating an AIDS-free 1 generation. We call on the U.S. government to do the following: 1. Reaffirm U.S. commitment to meeting its goals of supporting 6 million people on HIV/AIDS treatment; preventing 12 million new infections; and providing care for 12 million people by the end of 2013 as the U.S contribution to achieving universal access to HIV/AIDS prevention, treatment and care.

A decade ago following the historic United Nations General Assembly Special Session on HIV/AIDS the first time in the General Assembly took up a specific health topic member states, including the U.S., committed to annual global expenditures of $7-10 billion for low- and middle-income countries to support HIV/AIDS prevention, 2 treatment, care, and research efforts. Much progress has been made, but today, despite laudable efforts, new infections still outpace the global communitys ability to enroll patients on treatment by 2-to-1. The current burden of HIV/AIDS, which still claims nearly 2 million lives each year, remains a significant barrier to progress and 3 development. 2. Fulfill the remainder of the United States threeyear, $4 billion pledge to the Global Fund to Fight AIDS, Tuberculosis and Malaria for 2011 through 2013 and lead in actions to facilitate other G8 countries to also fulfill their pledges, while fostering new donors.

Background
As members of the InterAction G8/G20 Task Force- a group of nongovernmental advocacy and implementing organizations - we commend the United States for its persistent leadership on global health, and particularly HIV/AIDS. Over the past decade, the U.S. government 2

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The Global Fund remains one of the most effective, efficient and transparent global health institutions available. Between 2002 and 2010, the Global Fund approved $21.7 billion to support HIV/AIDS treatment for 3 million people, detected and treated 7.7 million cases of tuberculosis, and distributed 160 million insecticide-treated nets, helping to save the lives of roughly 6.5 million people in 150 4 countries. Representing nearly one-quarter of international public HIV funding, the Global Fund often operates seamlessly alongside U.S. HIV/AIDS programs in partner countries helping them address current challenges and prepare for future ones. In addition, the Global Funds individual strategy plays an essential role contributing to the achievement of global targets around HIV/AIDS, TB 5 and malaria. Despite this record of achievement, the Global Fund is in the midst of its worst funding constraints since the organization was created in 2002. Between 2010 and 2011 funding disbursed by the Global Fund declined by 16%, or nearly $530 million, due in large part to several donors reneging on previous financial commitments made 6 to the Fund. Several European countries, including Italy and Spain, have backed away from financial pledges made in previous years of more than $100 million each. Several others, including Greece, Iceland and Portugal have not made any new commitments, all resulting in the Global Funds recent decision to postpone its latest funding round. As a founding member of the Global Fund, the U.S. should continue to lead by fulfilling the remainder of its three-year, $4 billion pledge to the Global Fund, and ensure such funding does not replace U.S. bilateral funding for HIV/AIDS. The U.S. should also play an active role in the Global Fund reform process by supporting recommendations from the High Level Panel and help facilitate their implementation to improve the efficiency and effectiveness of how the organization operates. In addition to fulfilling their commitments, donors should look for ways to increase value for money in HIV/AIDS funding by ensuring the cost-effectiveness of their interventions. Given increasingly constrained resources and the need to better health outcomes, G8 countries should conduct their own bilateral and multilateral aid 3

reviews similar to that conducted by the United Kingdom to identify strategic leverage points for 7 investments that improve health outcomes. 3. Continue investments to develop technology and systems for a sustained global response to HIV/AIDS. The U.S. should honor commitments made in research, innovation and capacity development, particularly efforts to strengthen national health systems by training 140,000 new health workers, eliminate global pediatric HIV/AIDS, and help facilitate the development and introduction of new preventive, diagnostic, and treatment technologies.

The goal of achieving an AIDS-free generation can only be accomplished and sustained through combined investments that address both short-term and long-term goals. The U.S., along with other donors and partner countries, should uphold existing commitments to improve health systems, particularly through health workforce development, while also investing in the research, technology and innovation that offers new potential to alter the HIV/AIDS pandemic. We welcome U.S. efforts to develop new innovative approaches to service delivery including the strategic integration of HIV/AIDS programs with cervical and breast cancer. However, we also urge the U.S. to continue its leading efforts in HIV/AIDS research and development, an area that saw landmark advancements over the past two years in vaccines, microbicides, pre-exposure prophylaxis using antiretrovirals (PrEP), and antiretroviral treatment as prevention. In 2011, the HIV Prevention Trials Network (HPTN) 052 trial established that use of antiretroviral therapy (ART) by HIV-positive individuals reduced transmission to their partners by 96%, provinganother firstthe effectiveness of treatment as a important dimension of HIV prevention strategies. In 2010, funders invested a total of $1.19 billion USD in research and development (R&D) for four key prevention options: preventive HIV vaccines, microbicides, preexposure prophylaxis using ARVs, and operations research related to male circumcision. Even with difficult financial constraints, funders, including the U.S.,

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demonstrated the critical need for effective and accessible HIV prevention options to alter the long-term trajectory of the epidemic. There are opportunities to continue the historic progress of the past several years, to not only refine these technologies, but also to eventually see them to markets for use by those who need them. The U.S. should continue its strong support and leadership in these areas.

6 Institute for Health Metrics and Evaluation, University of Washington. Financing Global Health 2011: Continued growth as MDG deadline approaches. Seattle, WA. 7 United Kingdom, Department of International Development. 2011. UK aid: Changing lives, delivering results. London, UK.

While the statement is not designed to be a consensus position of the contributors, it has been endorsed by InterAction leadership. The recommendations were developed by a team of task force members who are listed below. Center for Global Development Elizabeth Glaser Pediatric AIDS Foundation Family Care International Global Health Council InterAction Management Sciences for Health Population Action International PSI (Population Services International) Trade Union Sustainable Development Unit

End Notes
1 Secretary Hillary Rodham Clinton, Remarks on Creating an AIDSfree Generation, National Institutes of Health, Bethesda, Maryland, November 8, 2011. 2 United Nations General Assembly, Twenty-sixth special session. Declaration of commitment on HIV/AIDS (A/RES/S-26/2). August 2, 2001. 3 UNAIDS, World Health Organization, UNICEF. Global HIV/AIDS Response Progress Report 2011. 4 The Global Fund to Fight AIDS, Tuberculosis, and Malaria. Making a difference: Global Fund results report 2011. Geneva, Switzerland. 5 The Global Fund to Fight AIDS, Tuberculosis, and Malaria. 2011. The Global Fund Strategy 2012-2016: Investing for Impact. Geneva, Switzerland.