IN LESS THAN A DECADE, IMPOSSIBILity turned the corner into reality. Infusions of cash and technical support from international donors, as well as growing political will in some developing countries, have provided lifesaving antiretroviral drugs to an estimated 5 million people living with HIV/ AIDS in resource-poor regions. But now the global HIV/AIDS community must find a way to turn yet another corner by maintaining those 5 million patients on antiretrovirals and offering the drugs to millions more in the midst of a persistent global economic crisis. Even though the downward economic spiral began nearly 2 years ago, AIDS officials say the impact on international donors’ ability to meet funding and treatment goals for the next 4 to 5 years still is not clear. In 2008, the last full year for which data on funding commitments and actual disbursements are available, international donors promised US $8.7 billion for HIV/ AIDS programs. They delivered $7.7 billion. The gap between promises made and promises kept was substantially smaller in 2008 than in recent years. For example, international donors had committed to $6.6 billion in 2007 but paid $4.9 billion; in 2006, commitments totaled $5.6 billion compared with $3.9 billion paid out. International donors’ commitments in 2009 were nearly the same as in 2008, said Paul DeLay, MD, deputy executive director of the programme branch at the Joint United Nations Programme on HIV/AIDS (UNAIDS), which compiles the data. “But that’s because of money that was already in the pipeline,” he noted. Release of data on disbursements in 2009 is expected to coincide with the XVIII International AIDS Conference in Vienna, Austria, in July. For 2010, DeLay said, all commitments for HIV/AIDS, including funds from international donors, private sources such as philanthropic foundations, and the countries themselves, total about $16 billion. But UNAIDS has estimated that about $25 billion is needed this year to meet HIV/AIDS needs in lowand middle-income countries. “I don’t think that within the year we’ll be able to catch up; that’s about 35% to 40% that we still need to go,” he said. “When we ask [international donors] about future commitments, because of political implications, the donors are a little hesitant to give us real numbers,” he added. A couple of exceptions are Italy and Ireland, which have informed UNAIDS that they will reduce assistance they provide for global HIV/AIDS programs. “I’m struck by the realities of how long this economic crisis has lasted and we still don’t understand the longterm implications,” DeLay said. “The damage done to developing countries or the resilience of developing countries—we still don’t understand that.” WORLD’S MAJOR PLAYERS The 2 largest international donors for global HIV/AIDS programs are the United States, which provided about 51%, and the United Kingdom, about 13%, of the $7.7 billion paid out in 2008. The President’s Emergency Program for AIDS Relief (PEPFAR), which was initiated in 2003 by former US President George W. Bush, and the Global Fund to Fight AIDS, Tuberculosis and Malaria, which was created in 2002, provided the kick-start needed to provide antiretrovirals and to scale up health care capacity in developing nations. Since its inception, PEPFAR has provided about $32 billion, including $5 billion for the Global Fund and $950 million for tuberculosis programs. The Global Fund acts as a financier that takes in donor pledges and awards grants to support services in developing nations. Awards from the Fund represent about 20% of all HIV/AIDS funding from donor countries. Their results are impressive. The Global Fund, since its beginning, has disbursed funds that provide antiret-
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Jun 29, 2023
Pablo Andújar Guerrero 
Open Access
