Simon Rushton
Associate Fellow, Centre on Global Health Security

Each year on World AIDS Day, AIDS advocates are required to perform a delicate balancing act, on the one hand trumpeting progress that has been made in the fight against AIDS, on the other trying to avoid giving the impression that governments can afford to relax their efforts. This year striking that balance is even more difficult than normal.

UNAIDS' 2011 World AIDS Day Report contains some good news. The headline items show a reduction in the number of AIDS-related deaths (down to 1.8 million in 2010 as compared to 2.2 million in the middle of the last decade); a reduction in new HIV infections (2.7 million in 2010 as compared to 3.1 million a decade ago); and an increase in the number of people in low- and middle-income countries receiving treatment (the figure now stands at 6.6 million – a 20% increase over the previous year).

These good news stories, however, need to be seen against the background of some worrying trends. The number of new infections continues to significantly outpace the number of people being put on treatment. Funding for AIDS is down for the first time in the epidemic's history. And there are troubling signs that donor governments, confronted with a financial crisis and a range of competing spending priorities, are beginning to shift their attention elsewhere.

'Stepping on the Accelerator'

UNAIDS' Executive Director Michel Sidibé, as well as other key voices, are stressing that we are at a potential turning point, and that now is the time to 'step on the accelerator'. The theme for World AIDS Day 2011 is 'Getting to Zero' (zero new infections; zero discrimination; zero AIDS-related deaths). US Secretary of State Hilary Clinton has joined in, saying that an AIDS-free generation is possible and announced US$60 million in additional US funding for the AIDS response in sub-Saharan Africa.

Perhaps for the first time, there are serious reasons to doubt whether the progress which has been made so far can be sustained. Far from increasing their commitment, many donors have failed to deliver on the promises they had previously made.

The most striking illustration of this is the Global Fund's announcement last week of the effective cancellation of its next funding round. The Global Fund is by far the biggest multilateral funder for AIDS (as well as tuberculosis and malaria) and in October 2010 countries pledged their contributions to the Fund for the 2011-2013 period. The $11.7 billion pledged fell short of what the Global Fund estimated was needed. At the time some commentators felt that the outcome was disastrous; others that it was probably the best that could realistically be achieved in the current economic climate. Either way, over $2 billion of that was promised has not been received by the Fund. The result is that countries will now not be able to apply for new money until 2014 as the Fund focuses on trying to find ways to continue funding existing projects that are already underway. 

The global AIDS community needs to capitalise on the publicity that World AIDS Day provides. The good news stories need to be told, and the hope of 'getting to zero' is a powerful message. But perhaps more important still is communicating the fact that the AIDS response is facing its own financial crisis.

Podcast: Listen to Simon Rushton discuss global health strategies on AIDS

AIDS: Five Neglected Questions for Global Health Strategies
Briefing Paper, Simon Rushton, November 2011

Tackling AIDS and Building Health Systems: A Balancing Act?
Event audio, November 2011