Building Alliances for World Health Funding.

The last year has brought historic change in world consensus -- from writing off and abandoning almost everyone with HIV in African and other poor countries, to serious discussion of how treatment could be provided to many or most who need it. The key to this change was the widespread realization that HIV treatment could be made available for well under $500 per patient per year if generic competition is allowed, instead of far higher prices which, in practice, meant that widespread treatment in poor countries was not going to happen. This change became possible through the work of activists around the world, over the opposition of some of the world's richest corporations.

Today political leaders internationally are talking about how to raise the several billion dollars a year that worldwide access to antiretrovirals may cost even at the new low prices (since $500 per year is still far beyond the means of most individuals and governments in poor countries). The money, "spare change" in the world economy, is certainly possible; the real issue is building sustained political commitment that will last beyond the current flurry of attention.

What is the next step? We believe that now the AIDS community should help broaden the discussion beyond antiretrovirals alone, or treatment of people with HIV only, through alliances and coalitions to fund world health -- finding several billion new dollars a year for HIV, tuberculosis, malaria, other illnesses, clean water, nutrition, education, infrastructure, transparency, and whatever else is needed, funding cost-effective health projects which can differ greatly from place to place according to local needs.

Practical and Political Advantages

A campaign for world health funding has important practical advantages over a specific campaign for antiretroviral funding:

(1) Persons with HIV need antibiotics, nutrition, safe water, and many other kinds of care, as well as antiretrovirals. Many medical professionals in poor countries are asking for these other treatments first, to save lives now. It wouldn't make sense to say, "No, here are antiretrovirals only." Other health interventions must be available for rational care.

(2) It would be wrong and a political nightmare to limit treatment to persons with HIV -- to say to patients who need an antibiotic to save their life, for example, that they must be HIV positive to get it.

(3) Politically the AIDS community alone is unlikely to sustain enough of the current momentum to raise several billion dollars a year for antiretrovirals. Historically the world epidemic has been scandalously underfunded, for prevention and otherwise, and we have been unable to change that. But a larger campaign for health, focusing mainly but not entirely on poor countries, could bring in many more organizations, activists, and other supporters, and would have a very good chance of finding this money.

(4) The donors and the recipient countries will control how the money is spent through decisions made later, so the campaign now to find the money will not have much control over how it is ultimately spent. Politically this is fortunate, since it means we can work together for health funding, without fighting each other over where the money will go. We can build consensus now on transparency and accountability, to help assure that the funds will be well spent.

(5) The AIDS community today has a window of opportunity to use the recent world consensus and political momentum to broaden the discussion beyond AIDS, toward a larger health movement that can sustain victories and momentum into the future. It's the right thing to do, and it can build a solid base for future success.