“Obama has shown political will and leadership in doubling the pace of treatment initiation… he has made a down-payment on ending the AIDS crisis globally,” said Asia Russell, director of international policy at the health advocacy NGO, Health Global Access Project (Health GAP), which has been urging the US to take the lead in the global fight against HIV/AIDS.
In 2010, some 3.2 million people were accessing ARVs through the US President’s Emergency Plan for AIDS Relief (PEPFAR); globally, some 6.6 million people have access to HIV treatment out of an estimated 15 million who need it.
The pledge, however, does not come with an increase in PEPFAR funding from the US$48 billion pledged in 2008 for five years.
“We are looking at smarter programming and greater efficiencies, and costs are also coming down,” said Michael Strong, country coordinator for PEPFAR in Uganda. “We will continue existing programmes and increase the number of people on ARVs to six million.”
Strong noted that the US was also working to persuade other countries to take greater responsibility in the fight against HIV. “China, for instance, should not be a recipient of donor funds for HIV – it is the world’s second-largest economy,” he said. “We are urging rich countries like Germany and Sweden to commit fully to efforts to fight AIDS.”
Obama said the US would also provide ARVs to prevent mother-to-child HIV transmission to 1.5 million women, support 4.7 million male circumcisions in eastern and southern Africa, and fund the distribution of at least one billion male condoms.
“HPTN 052 [a large randomized controlled study that showed the effectiveness of ARVs as prevention] showed that treatment not only saves lives, but slashes rates of infection; Obama has shown that he is willing to take action on the basis of that science,” Russell added.
Obama has shown political will and leadership… he has made a down-payment on ending the AIDS crisis globallyThe news comes as a relief for those involved in the fight against HIV, which is severely underfunded and recently suffered an additional blow when the Global Fund to fight AIDS, Tuberculosis and Malaria was forced to cancel its 11th round of funding due to insufficient resources. Activists have called on donor countries to follow Obama’s lead in ensuring treatment is made available for all those in need.
“We are calling for an emergency donor conference within the next 200 days as an opportunity for donors to raise at least US$2 billion towards meeting the costs of treatment,” said Tido von Schoen-Angerer, executive director of the Médecins Sans Frontières (MSF) Access Campaign. “It is very frustrating that we have had such a year of scientific achievement in terms of understanding how to have real impact and possibly end the epidemic, but at the same time funding is running out and we risk going backwards in the fight against HIV.”
Obama’s announcement on 1 December, World AIDS Day, was welcomed with cautious optimism in developing countries. “If the pledge is kept, it will be an important step in the global goal of getting 15 million people on treatment by 2015, but it is important to realize that we are not out of the woods yet, unless the rich countries of the north keep their pledges to the Global Fund… because this is the biggest source of funding for many poor countries,” said Nelson Otuoma, national coordinator of the Network of People Living with HIV/AIDS in Kenya (NEPHAK).
Health GAP’s Russell cautioned that high-burden countries would need to play their part in ensuring donor funds were used in the most effective way; in particular, countries such as Uganda – the only PEPFAR-funded country where new HIV infections are on the rise – would need to become more aggressive in using effective prevention technologies and scaled-up treatment programmes to show results.
“It will be vital for high-burden countries to step up and match Obama’s commitment with money, leadership and accountability,” she said.