The Washington Post
29 April 2002

The AIDS Fund Gets Going

Last 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.

To 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.