In-depth: TB - the year that was

GLOBAL: Straight talk with Global Fund director Michel Kazatchkine

JOHANNESBURG, 12 March 2010 (PlusNews) - The executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, Michel Kazatchkine, sat down with IRIN/PlusNews at the launch of the organization's 2010 report, where he answered some hard questions on what may be a turning point in HIV/AIDS funding.

QUESTION: Is AIDS still exceptional? Is it still the threat we once thought it was?

ANSWER: It's a huge threat; it's the largest epidemic the world has witnessed in history. It's about 34 million people living with HIV worldwide, and there are about 2 million deaths every year [from it] – deaths that should be preventable.

Why has the world focused so much on AIDS? It's about the dimension of the epidemic and the number of deaths - but because of the strong evidence that this epidemic was hitting people in the most productive age of life it was having huge societal, micro-economic and macro-economic [effect] ... So that has led to this concept of 'AIDS exceptionalism'.

Q. What would you say to arguments that we've invested too much in HIV and AIDS, to the detriment of other illnesses?

A. You may think [this has been] unfair to the other diseases but ... [the concept of AIDS as exceptional] has helped mobilize - as we've never seen before - resources that go to AIDS.

I want everyone to understand they're not just buying condoms or antiretroviral [ARV] drugs; these resources, in Africa, have allowed us to make progress when it comes to infrastructure, health worker training, to drug procurement ... Over a third of the overall funding of the Global Fund is actually going to strengthening health systems."

Q. How has the global recession affected HIV programmes?

A. None of our donors have not honoured their pledges to the Fund, despite the hard times. Where the impact may be the strongest is often in the [poor] countries. People may not realize that poor countries have suffered disproportionally more from the crisis than rich countries, because their exports have been going down and the price of imported goods has not decreased.

Poor countries, in times of crisis, have been struggling with keeping up their social investments ... their priorities are in the social sector. We've achieved significant progress that is very fragile. We know what we could achieve if we were to sustain or expand the funding ... now the challenge is our 2010 replenishment, and what will happen for the next three years.

Q. What is the future of HIV funding?

A. I mean, basically, the Global Fund and PEPFAR [the US President's Emergency Plan for AIDS Relief] together are providing 100 percent of the funding for ARV treatment in the developing world. The United States is the highest contributor to the Global Fund, contributing about 29 percent of Global Fund income. To me all news about flat-lining support is worrying. Flat-lining will not take us far enough in treatment or prevention – we need to expand.

Q. Are countries overly reliant on the Global Fund? Does that put national programmes at risk of funding delays?

A. I would argue that countries ... cannot deal with 24 donors. If you have to report to 24 people separately, countries ... [would be] drowning [in reporting commitments]. By having a Global Fund, we have a global political commitment ... and we significantly decrease transaction costs.

I am aware of a number of programmes where the money ... [has been delayed] ... Most often it's because we do not receive the request on time. There are bureaucratic reasons ... this is why we have a large amount of money channelled through civil society.

Q. Is there anything countries should be doing now in order to prepare themselves for a worst-case funding scenario?

A. No - countries have to build their ... plans to scale up prevention and treatment, and demonstrate what the macro- and micro-economic and societal impacts will be, to build a case for the donors. Never give up.

llg/kn/he

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