Europe: Show me the Money!
Both through adopting the UNAIDS Fast Track Strategy in 2015 and the UN Political Declaration on HIV and AIDS in 2016, governments across Europe and around the world have publicly pledged to significantly increase their funding to fight HIV.
So where is the money?
As these two key documents were being developed, I was indeed surprised to see how little detailed internal financial planning was being done as governments got ready to approve them. You would think politicians would realise that their decisions have cost implications: two key questions to ask any politician is how much will his/her promises cost and how these costs will be met.
For example, in adopting the Political Declaration (http://www.hlm2016aids.unaids.org/wp-content/uploads/2016/06/2016-political-declaration-HIV-AIDS_en.pdf), the relevant governments in Eastern Europe and Central Asia have joined with others in committing to work towards reducing the number of new HIV infections among young people and adults (aged 15 and older) in their region by 75% to 44,000. Similarly, governments in Western and Central Europe and North America have committed to the same percentage reduction in new infections to 53,000.
The Political Declaration also commits governments to expanding community-led service delivery by 2030 to at least 30% of all service delivery. The governments also promised to ensure that resources allocated for social enablers like advocacy, community and political mobilization, outreach as well as human rights programmes would reach 8% of total AIDS expenditure by 2020. That’s less than 5 years from now!
However, as noted in a recent study published by the Kaiser Foundation and UNAIDS, donor government funding for HIV fell in 2015 for first time in 5 years (http://www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2016/july/20150815_kaiser). For most donor governments assessed, funding to support HIV efforts in low- and middle-income countries decreased from US$8.6 billion in 2014 to US$7.5 billion. A significant amount of donor funding comes from certain EU countries that are facing their own financial challenges resulting, for example, from the refugee crisis, years of fiscal austerity, upcoming possible changes in political leadership, and of course the still unclear impacts of Brexit.
So where does this leave us in Europe, with a rebounding HIV epidemic in key major cities among men who have sex with men, an ongoing ignored epidemic among migrants, and the fastest growing epidemic globally in Eastern Europe and Central Asia? The prospects are not looking good. I understand UNAIDS is finally considering a Plan B to their Fast-Track Strategy after choosing not to develop one previously.
At the release of the Kaiser Foundation document, Luiz Loures, UNAIDS Deputy Executive Director, was quoted as saying: “The decline in international funding for the HIV response is worrying.” Franky, I think it is well beyond just ‘worrying’ now: we only have slightly over 4 years to the 2020 deadline to make a significant dent in the epidemic if we are to reach our 2030 targets. That governments could have made commitments without having the resources or the will to deliver on them would be profoundly irresponsible.
No doubt, some countries will achieve their 2020 and/or 2030 commitments. However, we need to closely monitor governments against their HIV commitments, including the Political Declaration. And we urgently need a feasible Plan B.