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More funding is required to beat the global AIDS epidemic. But who will pay for it in Africa? Linda Nordling asks.
Double the funding for AIDS. That was the answer to the question of how the world can meet its target of beating the global epidemic by 2030 from a high-level panel of experts and policymakers last month (June 2015).
It is one thing to estimate the money required to achieve a goal, but quite another to find the funding and put it to the essential use. Especially in countries where there is precious little money in the first place, as in the hardest-hit countries in Sub-Saharan Africa.
“An unprecedented combination of domestic and international support will be necessary to meet the copious needs for prevention, treatment and research programmes if recent gains in the fight against AIDS are not to be lost.”
Here, an unprecedented combination of domestic and international support will be necessary to meet the copious needs for prevention, treatment and research programmes if recent gains in the fight against AIDS are not to be lost.
Last month’s report was produced by the United Nations Programme on HIV/AIDS — Lancet Commission, a group made up of 38 heads of state, senior scientists, AIDS activists and Hollywood celebrities. Its findings were presented in a special 50-page supplement to The Lancet on 25 June , following on from two years of deliberation.
The report says that the world has made progress in containing the disease in recent years, particularly in the large-scale rollout of antiretroviral therapy in poor countries and by producing new prevention methods such as treatment-as-prevention.
But keeping the disease’s current global spending level of US$19 billion annually is likely to put these gains at risk, it says, leading to a resurgence of HIV infections, AIDS-related deaths and the associated costs in hard-hit countries.
Indeed, it estimates that an unprecedented and rapid increase to US$36 billion a year is needed to meet the United Nation’s goal of eliminating HIV as a public health target by 2030.
Spreading it out
The report adds that with many developing country economies growing at a faster pace than developed ones, the former should shoulder a growing proportion of the costs of its AIDS programmes.
The way that the money is spent is also important, the report notes. In most of Africa, the national AIDS programmes are not well integrated with the rest of the national health system. This translates into a lack of ownership at the country level, and reinforces the view of AIDS as a special disease category, which could fuel stigma.
While some developing countries, including Brazil and Thailand, could shoulder more of its AIDS costs, the situation in Africa is different. Despite the continent’s growing economies, the large scale of its AIDS epidemic means the financial burden will simply be too great.
As the report says: “Even under the most optimum resource allocation and management, the financial burden on the most affected African countries remains exorbitant.”
The way forward
So who should pay for scaling up AIDS programmes in Africa? And what role do African governments have in securing these investments for its people?
First and foremost, the countries that can afford to do so should offer to pay for a larger share of their AIDS treatment, prevention and research programmes. Efforts should be made to integrate AIDS treatment with the rest of the health service to ensure that both local and foreign investments from help strengthen the health system as a whole.
“If these vulnerable groups are not targeted with appropriate — and above all compassionate — AIDS programmes, a scale-up of funding in Africa, and elsewhere with a heavy HIV burden, will be misspent.”
Secondly, African nations need to keep investing in their local scientific capacity. Local research is needed to inform how to best spend AIDS funding — what prevention measures work in what contexts, and where additional AIDS clinics are needed. This cannot be done as well in London or Toronto. In other words, Africa needs to build its own capacity to carry out research instead of relying on studies being done by those from the global North.
Finally, governments should espouse an evidence-based approach to AIDS and commit to supporting marginalised communities. In Africa, this is particularly pertinent in the context of the continent’s many laws criminalising homosexuality, which have been found to exacerbate HIV spread in this group. 
Protect the vulnerable
Following on from the last point above, the move to promote more domestic ownership of AIDS programmes must not be allowed to interrupt support for high-risk and marginalised groups such as sex workers, men who have sex with men or drug users.
If these vulnerable groups are not targeted with appropriate — and above all compassionate — AIDS programmes, a scale-up of funding in Africa, and elsewhere with a heavy HIV burden, will be misspent. And that way, everybody loses.
This article has been produced by SciDev.Net's Sub-Saharan Africa desk.
 Peter Piot and others Defeating AIDS: Advancing global health (The Lancet, 25 June 2015)
 Academy of Science of South Africa (ASSAf) Diversity in Human Sexuality: Implications for Policy in Africa (ASSAf, May 2015)