Global Fund: Global Fund: Helping Fund the Just Helping Fund the Just

FightFight

Global AIDS ForumGlobal AIDS Forum

January 7, 2003January 7, 2003

Overview of Overview of PresentationPresentation

Global FundGlobal Fund– What is the Global Fund?What is the Global Fund?– Why do we need to fund it?Why do we need to fund it?

Roundtable TopicsRoundtable Topics– FinanceFinance– TargetingTargeting– Program/Activity AreaProgram/Activity Area– Intellectual PropertyIntellectual Property

What is the Global What is the Global Fund?Fund?

Global Fund is a financial instrument, not Global Fund is a financial instrument, not an implementing entityan implementing entity

Fund will base its work on programs that Fund will base its work on programs that reflect national ownership, respecting reflect national ownership, respecting country sovereigntycountry sovereignty

Fund will evaluate proposals and distribute Fund will evaluate proposals and distribute grants, with a priority on countries most at grants, with a priority on countries most at riskrisk

Governing board includes equal amount of Governing board includes equal amount of donor and developing countriesdonor and developing countries

Why give to the Why give to the fund?fund?

Empower countries financially to do Empower countries financially to do their own worktheir own work

Minimize global security Minimize global security threats/instabilitythreats/instability

Advance gender equality & alleviate Advance gender equality & alleviate povertypoverty

Ethical/Moral obligation to assist in Ethical/Moral obligation to assist in humanitarian crisishumanitarian crisis

Roundtable Roundtable TopicsTopics

FinanceFinanceTargetingTargetingProgram/Activity AreaProgram/Activity Area Intellectual PropertyIntellectual Property

Financial GoalsFinancial Goals

US $7 billion by end of 2003US $7 billion by end of 2003 US $10.5 billion by 2005US $10.5 billion by 2005 US $15 billion by 2007US $15 billion by 2007 US $21 - $25 billion by 2015US $21 - $25 billion by 2015

Participation GoalsParticipation Goals

To involve as many facets of society To involve as many facets of society in financing the alleviation of in financing the alleviation of HIV/AIDS and in providing services HIV/AIDS and in providing services for those impactedfor those impacted

Global Fund Financial Global Fund Financial PredicamentPredicament

National Government PledgesNational Government Pledges US $2.0 US $2.0 billionbillion

Private Sector PledgesPrivate Sector Pledges US $100 US $100 millionmillion

Total PledgesTotal Pledges US $2.1 billion US $2.1 billion

Pledge PromisesPledge Promises US $1.6 billion US $1.6 billion

The Global Funds The Global Funds ChallengeChallenge

Inadequate pledge amountsInadequate pledge amounts Failed delivery of pledgesFailed delivery of pledges

ChallengesChallenges

Help us fund the just fightHelp us fund the just fight

Challenge #1: Challenge #1: UNAIDSUNAIDS

To raise the necessary US$10.5 To raise the necessary US$10.5 billion by 2005billion by 2005

To have sustainable financial To have sustainable financial resources for the Fund’s future resources for the Fund’s future projectsprojects

Challenge #2: Challenge #2: National GovernmentsNational Governments

Short term: Annually allocate a Short term: Annually allocate a percentage of your GDP to the Fundpercentage of your GDP to the Fund

Long term: Establish a multilateral Long term: Establish a multilateral taxing mechanism as a financial taxing mechanism as a financial resource for the Fundresource for the Fund

Challenge #3: Private Challenge #3: Private Companies and Companies and

FoundationsFoundations Add 25 private partners annuallyAdd 25 private partners annually Designate “HIV/AIDS Goodwill Designate “HIV/AIDS Goodwill

Ambassadors” such as the Gates Ambassadors” such as the Gates Foundation to help us build Foundation to help us build partnerships with this sectorpartnerships with this sector

Challenge #4: NGO Challenge #4: NGO community and community and citizens’ groupscitizens’ groups

Assist the Fund in fundraising by Assist the Fund in fundraising by educating the public and private educating the public and private sectors about the urgency and needs sectors about the urgency and needs of the AIDS crisisof the AIDS crisis

Challenge #5: Challenge #5: International Lending International Lending

InstitutionsInstitutions Forgive at least 25% of highly Forgive at least 25% of highly

indebted and poor countries’ debt on indebted and poor countries’ debt on the condition that this money is the condition that this money is earmarked for social sectors earmarked for social sectors including appropriate HIV/AIDS including appropriate HIV/AIDS programsprograms

TargetingTargeting

The Global Fund places priority onThe Global Fund places priority on– Areas with greatest burden of diseaseAreas with greatest burden of disease– Interventions that address social and Interventions that address social and

gender inequalities and behavioral gender inequalities and behavioral practicespractices

– Areas in conflict and distressAreas in conflict and distress

Targeting Developing Targeting Developing CountriesCountries

96% of people living with HIV/AIDS 96% of people living with HIV/AIDS live in developing countrieslive in developing countries– Sub-Saharan Africa is the most affected Sub-Saharan Africa is the most affected

region with 29.4 million people living region with 29.4 million people living with AIDS.with AIDS.

Social and and economic impact of Social and and economic impact of AIDS is greatest in developing AIDS is greatest in developing nationsnations

Targeting Targeting

More specific targeting is neededMore specific targeting is needed– WomenWomen– Mothers and ChildrenMothers and Children– Youth ages 15-24Youth ages 15-24– Other vulnerable populationsOther vulnerable populations

WomenWomen

Fastest growing rate of infectionFastest growing rate of infection Gender inequalities in sexual Gender inequalities in sexual

behaviors makes women more behaviors makes women more vulnerablevulnerable

Women’s physiology increases risk of Women’s physiology increases risk of infectioninfection

Women are key to socio-economic Women are key to socio-economic cohesioncohesion

Mothers & ChildrenMothers & Children

1500 HIV positive infants are born 1500 HIV positive infants are born daily, 95% in developing countriesdaily, 95% in developing countries

Transmission rates are increased due Transmission rates are increased due to cultural norms to cultural norms – Abortion is prohibitedAbortion is prohibited– Breastfeeding is sole optionBreastfeeding is sole option– Low rate of pre/post natal care Low rate of pre/post natal care

YouthYouth

Half of all new infections (over 7000 Half of all new infections (over 7000 daily) are young people between 15-24daily) are young people between 15-24

Youth are vulnerableYouth are vulnerable– Risky sexual behaviorRisky sexual behavior– Substance abuseSubstance abuse– Lack of access to information and health Lack of access to information and health

carecare Young women and girls are most Young women and girls are most

vulnerablevulnerable

Other vulnerable Other vulnerable populationspopulations

Injecting drug usersInjecting drug users Sex workersSex workers Homosexual men having unsafe sexHomosexual men having unsafe sex PrisonersPrisoners Migrants and refugeesMigrants and refugees

All have high HIV prevalence rates All have high HIV prevalence rates and rates of transmission to other and rates of transmission to other populationspopulations

Effective Effective programmingprogramming

Education programs to change Education programs to change behaviorbehavior

Treatment options for mothers and Treatment options for mothers and babiesbabies

Education programs tailored for Education programs tailored for youthyouth

Targeted programs for sex workersTargeted programs for sex workers

Program/Activity Program/Activity AreaArea

Who Can ApplyWho Can Apply Characteristics of Successful Characteristics of Successful

ProposalsProposals Ideas for the FutureIdeas for the Future

Who Can ApplyWho Can Apply

National Country Coordination National Country Coordination Mechanism (CCM)Mechanism (CCM)

Regional CCM (Multiple Regional CCM (Multiple Countries/Small Island States)Countries/Small Island States)

Sub-national CCMSub-national CCM Individual OrganizationsIndividual Organizations

Characteristics of Characteristics of Successful ProposalsSuccessful Proposals

Soundness of approachSoundness of approach Feasible program implementationFeasible program implementation Potential for sustainabilityPotential for sustainability Evaluation and analysisEvaluation and analysis

Soundness of Soundness of ApproachApproach

Consistent with internationally Consistent with internationally accepted best practicesaccepted best practices

Priority to most affected/at risk Priority to most affected/at risk groupsgroups

Develops, strengthens, expands Develops, strengthens, expands partnershipspartnerships

Eliminate stigma and discriminationEliminate stigma and discrimination Respect intellectual property rightsRespect intellectual property rights

Feasible Program Feasible Program ImplementationImplementation

Programmatically and technically Programmatically and technically specific to country’s needsspecific to country’s needs

Transparent in financial arrangementsTransparent in financial arrangements Increase quality and coverage of Increase quality and coverage of

proven and effective practicesproven and effective practices Augments/coordinates with existing Augments/coordinates with existing

regional and national programsregional and national programs Uses equitable supply and distribution Uses equitable supply and distribution

systems systems

Potential for Potential for SustainabilitySustainability

Sustained political involvement for Sustained political involvement for allocation of national resourcesallocation of national resources

Strategy for ensuring that Global Strategy for ensuring that Global Fund investments will be additive Fund investments will be additive and catalyticand catalytic

Approved by Country Coordination Approved by Country Coordination MechanismMechanism

Evaluation and Evaluation and AnalysisAnalysis

Results focused using a clear and Results focused using a clear and measurable set of indicatorsmeasurable set of indicators

Include a monitoring and evaluation Include a monitoring and evaluation mechanismmechanism

Ideas for the FutureIdeas for the Future

Maintain balance between prevention, Maintain balance between prevention, treatment, and supporttreatment, and support

Continued CCM efforts to coordinate Continued CCM efforts to coordinate with NGOs and other smaller with NGOs and other smaller organizationsorganizations

More in-depth monitoring process to More in-depth monitoring process to ensure maximized successensure maximized success

Expanded support of programs directed Expanded support of programs directed at previously specified targets at previously specified targets

Intellectual PropertyIntellectual Property

BackgroundBackground What is intellectual property?What is intellectual property? TRIPS AgreementTRIPS Agreement Doha and going forwardDoha and going forward Relation to Global Fund effortsRelation to Global Fund efforts

Problems for poor Problems for poor countriescountries

High prices of patented High prices of patented pharmaceuticalspharmaceuticals

Even generics unaffordable to Even generics unaffordable to poorest countriespoorest countries

Limited opportunity to procure Limited opportunity to procure genericsgenerics– Few countries have ability to produce Few countries have ability to produce – Trade agreements limit generic exportsTrade agreements limit generic exports

Recommended Recommended SolutionSolution

Waiver for AIDS medications for Waiver for AIDS medications for needy countriesneedy countries– Protections against re-importation and Protections against re-importation and

parallel importing to rich countries and parallel importing to rich countries and potentially for middle income countriespotentially for middle income countries

– Requires tight definition of needy Requires tight definition of needy countriescountries

Other solutionsOther solutions

To prevent reimportation, UN To prevent reimportation, UN purchases drugs in bulk at purchases drugs in bulk at discounted prices, becomes sole discounted prices, becomes sole distributordistributor

Increase incentive subsidies for R&D Increase incentive subsidies for R&D to produce at marginal cost to produce at marginal cost (separate incentives from low cost (separate incentives from low cost distribution)distribution)

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