US fights back in AIDS funding row

Producer: Bharati Jagdish
First broadcast: 15 July 04, Radio Singapore International

The United States has fought back against widespread attacks on its AIDS policies, insisting that it is leading the fight against the killer epidemic and spending more money on it than the rest of the world combined.

This, after it rejected a plea from United Nations Secretary General Kofi Annan to inject 1 billion dollars- a- year into a global AIDS fund.

US Global AIDS Coordinator, Randall Tobias, said that the 200 million dollars that the US is planning to contribute to the Global Fund next year is more than adequate for putting programmes in place.

Washington has faced a storm of criticism at the ongoing AIDS summit in Thailand over its funding policy, especially over a 15-billion-dollar five-year Emergency Plan for AIDS Relief which is mainly directed towards Vietnam and 14 countries in Africa and the Caribbean.

Activists complain that the countries were chosen because they share the US philosophy of stressing abstinence as a tool for preventing HIV rather than condoms.

They say the US should instead give much of that money to the Global Fund to Fight AIDS, Tuberculosis and Malaria which reaches out to 128 countries.

The Global Fund was launched in 2002 as Kofi Annan's brainchild and requires 3 billion dollars next year.

For more on this, Bharati Jagdish (BJ) spoke to Senior Policy Adviser at UNAIDS, Michael Iskowitz (MI) who's attending the AIDS summit in Bangkok.

MI: "I think there's a difference of opinion about both the amount of investment and how the money flows. The US, this year, will spend about 2.4 billion dollars in the fight against AIDS, about 550 million of which will go to the Global Fund, so they make a major contribution to the Global Fund and are the largest donor to the Global Fund and spend the rest of their money through bilateral funding of community-based organisations and governments directly."

BJ: So what is the problem with that? Isn't that a good approach as well?

MI: "Certainly, from UNAIDS perspective, we want a fully-funded response that will require funding of the Global Fund, but will also require a variety of other funding mechanisms - through the World Bank, through funding individual organisations, through private-sector funding. But what's most important if people are going to use a variety of different funding mechanisms, is that it comes together on the ground in a way that's coordinated because if everybody on the ground does their own thing, it's very difficult for countries to have a coordinated plan and programme. A coordinated approach would require all the donors to come together and make sure that they're not all doing the same thing, that they're not duplicating efforts, they're not over-taxing national governments. It will require everybody to their part, but as part of one system."

BJ: And the best way to ensure this is to contribute to the Global Fund instead? Is that what you're saying?

MI: "We certainly hope that the US continues to contribute to the Global Fund and increases its contributions to the Fund, but we also support them using their money directly if that's what they believe makes it most sustainable. The US has agreed to support this process. We hope that even though their money goes directly to the ground, they will work with others to make sure that it's well-coordinated on the ground."

BJ: How do you plan to bring about greater coordination on the ground - a more unified strategy on the ground?

MI: "The first step in that direction happened in Washington DC in April where all of the major donors agreed to this "3-1" system that UNAIDS had proposed which means that all donors will agree to support one country's strategy so that if the country has put together its plan for prevention and treatment, rather than each doing their own thing in a random fashion, 3 countries will look at the plan and each of them will pick a piece of the plan to finance. But there would also be one national authority or a partnership forum where all the donors and all the stakeholders are at the table, so that everybody knows which piece everybody's doing. And there'll be one monitoring and evaluation system."

BJ: And the US has supported this system too, hasn't it?

MI: "It's a very promising step that all of the donors including the Global Fund and the World Bank, the United States, the United Kingdom and all major donors in world have now agreed to this process. I think that now, our real challenge is to see country after country make sure that they can figure out how to make it work. Almost every country has a national plan, so that's a step in the right direction."

BJ: It seems that the US thinks that the Global Fund needs to focus its energy on accelerating its infrastructure and capabilities on the ground so that it can put the money that's already been collected to good use before asking for more money. Are the funds not being used efficiently at the moment?

MI: "They are being used efficiently. The Global Fund is not supposed to implement programmes. It's a financing mechanism and so it requires people on the ground to actually put those programmes into action and it is true that local capacity - the doctors and the nurses and the infrastructure necessary to make those programmes happen continues to be a challenge."

BJ: Now, the UN's special envoy on HIV/AIDS to Africa, Stephen Lewis, has compared America's reluctance to contribute more extensively to the Global Fund with the US's stance on going to war in Iraq without UN endorsement. Do you think this is a fair comparison?

MI: "I don't actually. I think we continue to say that it's really important that things be coordinated on the ground. We agree that a go-it-alone strategy is not a good strategy. That doesn't mean that money can't get to the ground through a variety of ways. But once it gets to the ground, it's very important that people are not going it alone. That we are working towards one coordinated plan on the ground, so that we can maximise our impact and scale up essential treatment and prevention for everybody who needs them."

BJ: Do you expect the US, in addition to participating in a more coordinated effort, to also change its stance and offer more money to the Global Fund in the near future?

MI: "I think the United States will continue to be the largest contributor to the Global Fund and it would not surprise me at all if the amount that they're contributing to the Fund increases. Whether or not that will be a billion dollars in a single year, I'm not sure. But it is likely that next year, the US will contribute at least what it contributed this year which is 550 million. The United States has a provision in its law that was passed by Congress. This law says that no more than one-third of the money in the Global Fund can come from the US. The Congress said that the US should do its fair share, but everybody else should do their fair share as well. The US has always been at one-third of the Fund."

BJ: So why then is Kofi Annan expecting the US to do more than its fair share now?

MI: "I think what the secretary-general said is that everybody needs to do more. He also wanted there to be a billion dollars from the European Union and to the extent that other donors continue to put more money in the Fund, it will allow the US to put more money in the Fund as well, because they will feel they still have to fulfill they're one-third ceiling. So if there's more money in the Fund from other donors, the US can also give more money because one-third of that larger amount will naturally be larger too."