Refocused Global Fund starts to hit key populations

A successful community-driven India HIV/AIDS Alliance programme that provided critical services to nearly 500,000 members of key population groups has had to close. What impact are recent decisions by the Global Fund to fight AIDS, Tuberculosis and Malaria going to have on the lives of key populations?

This month sees the fifth replenishment conference for the Global Fund taking place in Québec, Canada. The Fund provides more than 20% of global funding for HIV/AIDS, with 95% of that funding coming from donor countries.

Pledges are currently coming in to meet a goal of US$13bn set to fund 2017-2019 programmatic work.

We know the money is there for ending AIDS. What is lacking is the political will.

However, Javier Hourcade Bellocq, Head of Influence at the Alliance secretariat, warns that even with this goal reached – and it is far from certain that it will be – it is insufficient to set the world on the path needed to achieve the United Nations’ declaration to end AIDS by 2030.

“UNAIDS has estimated that US$26bn is needed on a yearly basis for the global response to AIDS. The truth is that there’s been a deprioritisation of HIV/AIDS on the health agenda of many donors. We know the money is there for ending AIDS. What is lacking is the political will.”

pechanHijra friends at a gathering. © Ashok /the Alliance/ Photovoice

Funding crisis

One consequence of the resulting funding crisis is that a new Global Fund eligibility policy was put in place. As a result of this policy, many middle-income countries and countries with lower HIV prevalence will soon have to ‘transition out’ of the Fund’s portfolio, on the basis that their governments should pay for their own HIV/AIDS responses.

“Whilst the Alliance supports and encourages national governments to take on more responsibility for funding their own HIV response,” says Javier Hourcade Bellocq, “we are concerned that the assumptions behind the eligibility policy fail to consider health inequalities within a country and a widespread lack of political will to fund services for key populations”.

Pehchan

Pehchan, a successful community-driven India HIV/AIDS Alliance programme, illustrates this point. It was the Global Fund’s largest single-country grant focused on the HIV response for key populations, but it was forced to close earlier this year when the Indian government de-prioritized it in its Global Fund application and then cut budgets to its national AIDS programme.

During its five years in operation, Pehchan established and strengthened more than 200 community-based organisations, mainly for men who have sex with men (MSM), transgender people and hijra, and through them linking 470,000 people to HIV services.

I was a counsellor but now there is nothing to do so I have gone back into sex work and begging.

Its closure, explains Sonal Mehta, incoming executive director of India HIV/AIDS Alliance, was the result of the Global Fund taking at face value India’s claim that the country had sufficient funding for HIV prevention. This, however, was based on the country receiving a match-funding loan promised by the World Bank – and the Indian Government, instituting its budget cuts and in any case unsympathetic to key populations, failed to provide the money the World Bank was to match.

The result: Pehchan was left caught in the middle and with no funds.

“We lost out on promises which everybody knew were false,” says Sonal Mehta. “The Global Fund knows the country well, they knew the [AIDS] budget was being cut, they knew this should not happen, but they said ‘this is for the Indian Government to decide’.”

The human cost of what she says was the Global Fund’s lack of resources and lack of mandate to negotiate with the Indian Government to ensure continued funding for AIDS programmes is huge.

She says: “We meet transgender people on the street who say ‘I was a counsellor [with a Pehchan-supported CBO] but now there is nothing to do so I have gone back into sex work and begging’. We were working with 470,000 people and of them less than half are getting services now.”

No longer global?

Pechan2Preparing for a performance in Mancherial, Andhra Pradesh. © Amit Bhargava/Corbis/Corbis 

India is not alone in lacking the political will to put money into prevention programmes, particularly for key populations. “I wonder who will put money into funding harm-reduction programmes or needle exchange in Ukraine now?” asked Javier Hourcade Bellocq, citing just one other example of where key populations may be at risk.

He fears that the Global Fund will lose its global mandate and only operate in low-income regions such as southern Africa, where AIDS is generalised, withdrawing completely from regions with concentrated epidemics, for example Latin America where 35% of transgender people are HIV positive.

“That wasn’t the principle for which the Global Fund was set up,” he says. “We have already given up many funding principles. We hear so often about the need ‘to frontload’, ‘to fast-track’ and all these other buzzwords so that by 2030 we end AIDS. But the behaviour of the global community shows the opposite happening. Essentially they say we need to speed up, but in practice they’re putting in less gasoline.”