“We cannot at the moment encourage in good faith an expansion of these programs,” Christoph Benn, the fund’s director of external relations, said Wednesday after a two-day meeting in Ghana of the board’s directors.
The decision comes at a time of growing clamor to scale up AIDS treatment in countries hardest hit by the disease, especially nations in sub-Saharan Africa.
A study earlier this year showed that treating infected people with antiretroviral drugs cuts their chance of transmitting the virus by 96 percent — leading to calls for a “treatment-as-prevention” strategy against the epidemic.
Other research has shown that adoption of circumcision by African men and more aggressive treatment of HIV-infected pregnant women can also drive HIV incidence down steeply. In a speech three weeks ago, Secretary of State Hillary Rodham Clinton said an “AIDS-free generation . . . is possible with the knowledge and interventions we have right now.”
With the Global Fund standing pat, that goal will be much more elusive.
The Global Fund has dispensed about $15 billion since its creation in 2002, including $2.8 billion this year. Nearly all of its money comes from Western industrialized countries, with the United States by far the largest donor. The money is distributed in competitive grants to health ministries and charities in needy countries.
About 14.2 million people in low- and middle-income countries, mostly in Africa, qualify on medical grounds for treatment with antiretroviral drugs. At least 6.6 million are now getting that treatment, with the Global Fund paying for the care of about 3.2 million people. A similar number are supported by the U.S. government through the President’s Emergency Plan for AIDS Relief (PEPFAR), created by President George W. Bush in 2003.
The fund needs $7 billion to pay for grants already awarded and has pledges to cover them. The European financial crisis, however, has cast an ominous shadow across this funding stream.
Italy, a big supporter in the early years, pledged to pay 130 million euros a year in 2009 and 2010 but has not made either payment. Spain pledged $200 million in 2010, but it reduced its contribution to $134 million and has not pledged anything for 2011, 2012 or 2013, according to Andrew Hurst, a Global Fund spokesman.
Matthew Kavanagh of Health GAP (Global Access Project), an advocacy organization in New York, called the Global Fund’s decison “irresponsible and reckless.” He characterized the amount of money needed to continue expansion of AIDS treatment as “a rounding error in the budgets of wealthy donor nations.”