Peter, thank you for your input.
Those of us in Southern Africa salute and celebrate the Global Fund for its life-saving interventions in the HIV response.
There is, however, currently a qualifier to the good news, and that is prevention.
As a proportion of total HIV funding, funding for HIV prevention in Global Fund grants has been declining. We recognize that this is mostly due to the imperative for countries to place more people on treatment. But the need to place more people on treatment is not only a factor of reaching those not on treatment, but also a factor of the total number of people living with HIV continuing to increase as the 2020 deadline for the 90-90-90 targets looms.
In Africa, the proportion of funding requested from the Global Fund in the 2014-2016 cycle that was dedicated to HIV prevention varies greatly by country, but the average (16%) is below the UNAIDS recommended “quarter for prevention”. We note with concern that the proportion for HIV prevention in the signed Global Fund grants (framework agreements) of many African countries (including Angola, Botswana, Sierra Leone, Somalia, South Sudan, Uganda and Zambia) was less than the proportion requested. There is an urgent imperative to increase “supply” from the Global Fund to meet countries’ HIV prevention programming demand.
Some of the key barriers to including HIV prevention activities in Global Fund funding appear to
include difficulties costing these activities accurately; a limited menu of evidence-based interventions (especially for AGYW); and inadequate participation of civil society representatives on writing teams where they often champion HIV prevention priorities.
The introduction of “matching funds” in the 2017-2019 funding cycle as a way of incentivizing countries to dedicate their allocation to specific HIV prevention priorities has led to dramatic increases in some countries for certain programs ranging from 172% increase in prevention spend for AGYW in Eswatini, to a 650% increase in spend for key populations and AGYW in Zimbabwe. Board documents from the 40th Global Fund Board meeting suggest that while the matching funds modality may not continue in the next cycle (2020-2022). It is imperative that these gains in prevention funding are not lost.
We note that some of the reasons for this move away from this funding is the perceived difficulties operationalizing spedn on these funds. The community-unfriendly nature of granting exacerbates this difficulty by making it more difficult for those closet to communities to access funds.
We would appeal to you and to the fund:
Firstly, include specific and binding language in the allocation letters for the 2020-2022 funding cycle to ensure countries maintain or increase funding in their grants for HIV prevention
Secondly, ensure there is adequate funding available to meet demand for HIV prevention programs. The Global Fund’s 6th replenishment conference in September 2019 is a key opportunity.
Finally, track and publish HIV prevention spending in countries, including by governments, other funding partners, and in Global Fund grants. There is often not a great deal of transparency around what countries are spending on HIV prevention, making it hard (or impossible) to hold decision-makers accountable. UNAIDS data is often not disaggregated by program area, and many National AIDS Spending Assessments are 5+ years old.
Agenda item 2Delivered by Jonathan Gunthorp, SRHR Africa Trust
Intervention on Leadership in the HIV Response on Behalf of SRHR Africa Trust
Tags: 43rd PCB Meeting