Tough to track billions flowing to fight AIDS

July 31st, 2008 - 9:17 am ICT by IANS  

By Anindita Ramaswamy
Washington, July 31 (DPA) Billions of dollars in international funding are flowing to developing countries to help them cope with AIDS, but there is little understanding about how these vast resources are actually spent or how effective they are in controlling the epidemic. International donor funding for AIDS has increased 30-fold from $300 million in 1996 to $8.9 billion in 2006. The aid is unprecedented in the history of global health.

But it is never enough.

For 2007, the joint United Nations programme on HIV/AIDS (UNAIDS) calculated a need of $18.1 billion. Even though donors - including the Group of Eight industrialised countries (G8), European Commission, Australia, Sweden - spent $10 billion, a shortfall remained.

If “universal access” - the ideal that everyone who needs treatment anywhere in the world should get it - is to be achieved by 2015, then an estimated $25 billion is required in the developing world, UNAIDS has said.

Funds for prevention are equally critical.

“We cannot treat our way out of this epidemic. For every two people put on treatment, five are newly infected with HIV,” said UNAIDS executive director Peter Piot.

The good news is that countries pledging assistance are quick to deliver.

Last year, international AIDS funding reached its highest commitment of $6.6 billion, of which $4.9 billion was actually disbursed, according to a report from UNAIDS and the non-profit Kaiser Family Foundation.

The US is the world’s largest donor, accounting for more than 40 percent of disbursements.

Last week, the US Congress approved a bill to re-authorise PEPFA - the president’s emergency plan for AIDS relief - with a commitment to spending $40 billion over five years to fight AIDS in developing countries.

But it’s hard to decipher how effective all this funding is.

“Part of the problem is that data are not shared easily by donors, with PEPFAR being the least transparent,” said Nandini Oomman, director of the HIV/AIDS Monitor at Washington think-tank Centre for Global Development (CGD).

CGD analyses three of the world’s largest initiatives - Global Fund for AIDS, TB and Malaria, PEPFAR and the World Bank’s Multi-country HIV/AIDS Programme for Africa - that together give $5 billion a year to developing countries.

The Global Fund publicly discloses the largest share of its financial data, and the World Bank conducts regular internal assessments.

“Even when data are collected, donors do not disaggregate it by treatment and prevention, so how can you determine cost-effectiveness?” Oomman asked.

Also, money given for AIDS is used in a wide range of sectors - making it complicated to sort through both the users and the actual amounts disbursed and used.

Accurately collecting and sharing data is a critical aspect of AIDS funding.

The 15 countries that PEPFAR focuses on receive more than 80 percent of all global AIDS funding. These are countries that account for half of the people living with HIV in the world.

But Ethiopia, a PEPFAR country with a relatively low HIV-prevalence rate, has the most committed money, a science magazine investigation revealed.

Rwanda, another PEPFAR country, gets $2,015 per infected person. But Congo, Central African Republic, Myanmar, Sudan and Zimbabwe, which together have 3.7 million infected people, get a mere $150 per infected person.

Six of the top 10 recipients of Global Fund money are also PEPFAR focus countries. Often, countries with the greatest need don’t get enough.

Syracuse University’s Jeremy Shiffman, a professor with a special interest in health care policy, sees the increased attention that AIDS receives as both a cause for celebration and concern.

“It is a reason for celebration because the disease has been neglected in the past and the tide may be turning against this humanitarian crisis.”

“It is reason for concern because there is growing evidence that the extensive focus on this one disease is crowding out resources and policy-maker attention for the many other causes of death and illness of the poor in the developing world,” he wrote.

As donors figure out how best to spend their money, somewhere in the world, every single day, nearly 7,000 new people are infected with HIV.

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