Nine ways funding for the global HIV response could go further

 A young girl living with Aids takes her drugs at her home in Ndiwa, western Kenya. Photograph: Simon Maina/AFP/Getty Images

A young girl living with AIDS takes her drugs at her home in Ndiwa, western Kenya. Photograph: Simon Maina/AFP/Getty Images

Story via The Guardian

1 | Protect and promote human rights

Public resources are wasted on enforcing laws that criminalise HIV transmission and dehumanise at-risk populations. By contrast, laws that protect at-risk populations are powerful, low-cost tools that help ensure that financial and scientific investments for HIV are not wasted. Enacting laws based on sound public health and human rights will ensure new prevention and treatment tools – such as PrEP [pre-exposure prophylaxis], male circumcision and microbicides – reach those who need them. Changes in the legal and policy environment, along with other interventions, could lower new adult HIV infections to an estimated 1.2 million by 2031 (compared to 2.1 million if current efforts continue unchanged). Mandeep Dhaliwal, UNDP

2 | Make drugs cheaper

One way to make limited funds go further is to challenge drug companies on the high price of life-saving drugs. The use of unmerited patents by pharmaceutical companies to secure monopolies on their products must stop. Make Medicines Affordable is working with civil society to challenge unmerited patents and useTrips agreement flexibilities. Julia Powell, International Treatment Preparedness Coalition

In lower middle-income countries, the average antiretroviral (ARV) treatment cost for a new adult patient is around $350 [£283]. Of that, just 40% is the cost of the ARV – 35% is non-ARV recurrent costs (clinical salaries, laboratory etc) and then 25% is programme management. We really need to dissect non-drug costs and find ways to reduce costs with regard to generic licensing and optimising manufacturing costs. Anand Reddi, Gilead Sciences

3 | Support LGBT groups

There are some great new global funds supporting funding for local and national LGBT groups so that they can gather data on access to medicines for their community, in a way that ensures their confidentiality and safety. The Rapid Response Fund, funded by the Elton John Aids Foundation (EJAF), the President’s Emergency Plan for Aids Relief (Pepfar) and UNAids, will support civil society organisations that are led by, or work closely with, MSM [men who have sex with men] and LGBT people and communities, to implement rapid responses to situations or events that threaten their access to HIV services. Grants of up to $20,000 [£16,000] are available. Mike Podmore, STOPAIDS

4 | Support adherence to ARVs

Drug resistance is a huge issue and one to which we are only just waking up. The World Health Organisation has produced a 2017-21 action plan which, I think, underlines that we have neglected to focus on adherence and support people not just to access ARVs, but to stay on them. Mike Podmore

5 | Integrate HIV into health sectors

Finance ministers tend to think in terms of sectors (eg health) or a clusters of sectors (eg the social sectors – education, health, social welfare), rather than in terms of individual issues like HIV. We need to integrate Aids financing into domestic health financing and make the argument to finance ministers that they need to increase investment in the social sectors, and health in particular. We need to underscore why this is an important investment in human capital and, therefore, in economic development. David Wilson, World Bank

6 | Collect and spend taxes on health

Some countries with major HIV epidemics have actually progressively reduced the share of the government budget they allocate to health, and many African countries with major HIV challenges collect a smaller share of GDP as revenue – and spend more collecting that small share – than comparable economies elsewhere. We must ensure that a significant share of the greater revenue collected is allocated to health, and spent as efficiently as possible. David Wilson

7 | Integrate HIV and water and sanitation programmes

Safe water can make an enormous difference to the health and wellbeing of people living with HIV. It can increase drug effectiveness by reducing diarrhoea and collaboration between HIV specialists at Safaids and in the water and sanitation sector have identified ways to integrate water and HIV programming more effectively in southern Africa to streamline investments. In addition, arecent systematic review showed that water and sanitation interventions to reduce morbidity among people living with HIV were cost-effective, particularly when incorporated into complementary programmes. Louisa Gosling, WaterAid

8 | Coordinate responses

In the HIV/Aids space, we can work with others focusing on health to share costs. In Malawi, for example, our mobile clinic teams test and treat for malaria and TB even though our core focus is HIV. Also, in our door-to-door testing pilot – where a team of eight canvases a village over a week to perform HIV tests – that same team will check for bed nets. If they do not have one, our HIV testing team will leave one and teach the family how to use it. One team, but two major health issues covered. Joel Goldman, The Elizabeth Taylor AIDS Foundation

9 | Push for more funding

We must reject the assumption that we will/can have less money and, instead, make it clear that less money, or even maintaining the same levels of funding, will lead to an increase in infections and deaths globally. Many organisations working on the global HIV and TB responses are shouting loudly about the funding alarm. It became even more urgent when the Kaiser Family Foundation found that global donor financing had reduced by 13% from 2014 to 2015. Our only way forward is to increase general public awareness and demand for donors and INGOs to increase HIV and TB funding up to 2020, and make it possible to end the epidemics by 2030. If not, we risk a terrifying rebound of the epidemics that we will struggle to get a grip on again. Mike Podmore

Read the full Q&A here.

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