29 April 2002
AIDS Fund Gets Going
June, at a summit organized by the United Nations, the world
signaled a new determination to fight the AIDS epidemic. Last
week brought the first fruits of that commitment. The new
Fund to Fight AIDS, Tuberculosis and Malaria announced
grants worth $ 378 million over two years to fight the disease
in 31 developing countries and indicated that it soon would
approve more two-year grants worth another $ 238 million.
This falls far short of the goal of $ 7 billion to $ 10 billion
a year set forth by U.N. Secretary General Kofi Annan. But
because some of the grants will go to treatment as well as
prevention programs, they may mark a conceptual breakthrough.
The world finally seems to recognize that treatment is not
just a moral obligation but an essential complement to prevention
efforts. You can't get people with HIV to change their behavior
or even come forward for testing if you have no treatment
to offer them. The Fund now faces a tough challenge.
It is under pressure to ramp up its grant-making process,
and there are welcome moves in Congress - from Sens. Dick
Durbin (D-Ill.) and Arlen Specter (R-Pa.), and possibly from
Sen. Jesse Helms (R-N.C.) - to make sure the United States
helps replenish the fund's coffers. At the same time, however,
the fund needs to convince many skeptics that it's up to this
task. It deliberately was set up as a lean outfit, outside
the umbrella of the United Nations or the World Bank; the
idea was that this might make it more efficient. But this
theory is unproven. Creating a new agency risks adding to
the list of donors that stressed developing countries must
cater to; Tanzania, for example, is said to produce 40,000
reports per year to keep its donors happy. Moreover, a lean
outfit necessarily lacks the capacity to monitor the quality
of programs in detail or to offer technical assistance in
designing them. If the Fund squeezes billions out of
donors and then wastes the cash, the cause of development
assistance will suffer.
avoid these pitfalls, the fund needs to form alliances with
other development agencies - even though it was doubts about
those same agencies that led to the fund's creation as an
independent entity. If a developing country already has prepared
a good AIDS program as part of its consultations with the
World Bank or other agencies, the Fund should not demand
that another program be drawn up. Equally, the Fund
should encourage outside health experts to provide technical
assistance to the programs it finances.
Whether the fund succeeds ultimately will depend on the donor
governments that created it. Out of frustration with existing
aid institutions, these governments decided to found a new
body. But the truth is that the shortcomings of existing institutions
often reflect the warring priorities of member governments,
and if the same conflicts are projected onto the new
Fund it may perform little better. The risk is that donor
governments will fail to allow the fund to function well,
then use that malfunction to justify paltry financial support.
Every year, some 5 million people are newly infected with
HIV. The world needs to fight back urgently.