Rapporteur report
Track C: Biomedical Prevention report by Nick Walsh
This symposium on The Future of Global Financing of HIV Prevention, Treatment, Care and Research allowed several discussants to provide some opening remarks, then examine key issues in more detail before the discussion was opened to the floor.
Michel Kazatchkine, head of the GFATM, began by outlining the challenges facing financing for donors and recipients. Donor funding is increasing and so it is crucial to ensure the sustainability of resources in order to guarantee predictability of funding which allows long term goal seeking in developing countries. Development aid now is a integral part of international politics, not just philanthropy. It is commitment to building a globalized world through the lens of development. Recipients need to identify the gaps between available resources and demand and between unmet need and demand. To really make a difference to malaria or AIDS we need ambitious requests. Unfortunately recent GFATM requests are not ambitious enough to shift the trajectory of these epidemics to manageable public health issues. Developing countries share of responsibility is to build sustainable health protection schemes. Anticipating cost is less expensive than paying later.
The Sydney Declaration calls for a greater proportion of investment in research. Judy Auerbach emphasised the challenges for HIV research. Good research can drive good policy. As UNAIDs has stated ‘you need to know your epidemic’. She asked ‘What is evidence?’ It is not only operations research, but also more basic research such as the biomedical sciences and epidemiology in order to drive new discoveries. In low and middle income countries agendas need to be conceived and conducted by local people relevant and timely to the local context. Building capacity needs to be across the spectrum of training needs from school to high education and workforce development. Finally we need to integrate research into the global HIV response, which the Sydney Declaration has begun to address. Ultimately tacking HIV is not only about the money but using what we have most effectively.
This initiation of the GFATM and PEPFAR have dramatically increased available funding. Debrework Zewdie acknowledged this the rapid increase in funding for HIV. She identified key challenges as having predictable, sustainable funding and to have a variety of domestic and international funding sources. We need to use funding efficiently and effectively and donors need to work together. She gave the example of the recent meeting in Rwanda with PEPFAR, the World Bank and GFATM. Ultimately affected individuals and countries need the opportunity for empowerment – we need to support them.
HIV funding cannot be disconnected from politics. Paul Bekkers emphasized the need to make sure that HIV is not pushed off the political agenda by other issues such as global warming. He pointed out that we need to be careful that there is no division between health systems and HIV development – they are interdependent. Harmonization of funding is an important mechanism to address this. Structural partnerships between the public and private sectors are also important, exemplified by insurance schemes developed and supported in partnership by government and private conglomerates.
The discussion then moved to examine some of the following points:.
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What are key costs? 2nd line therapy is much more expensive than 1st line, diagnostic testing is also a significant cost.
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The global economy is shifting the balance of economic power for example China and India may move from recipients to donors as their economies expand. Russia has already shifted from a recipient to recipient-donor.
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The global health workforce needed to tackle HIV is unevenly distributed, with a particular shift from the South to the North (the brain drain). How to stem this? A complex and as yet unanswered question.
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It is important that countries’ agenda are fulfilled through multilateral donor programs so that there is not a distortion of the public health agenda by individual donors.
The symposium finished with an open discussion and consensus that although there are many questions, the answers are complex. Ultimately it is sustained political will that is fundamental to continued efforts to address HIV at a global and local level.
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