Changes in response
The global response is undoubtedly better funded than ever before. At just under US$5 billion in 2003, global spending on HIV was 15 times higher than the US$300 million in the early days of the Alliance. But it is less than half of what developing countries need in 2005, according to UNAIDS.
Increasingly, donors, policy makers, and those involved in the HIV global response have recognised the importance of involving civil society. We have all learned lessons about the importance of protecting, promoting and fulfilling human rights and the need for a combination of approaches for prevention, treatment and reducing the risk and impact of HIV.
Civil society organisations have had a number of successes in:
- demanding that inactive governments take action
- taking the lead in initiating, planning and delivering responses
- setting the agenda at the international level
- calling pharmaceutical companies to account.
There has also been a growing realisation that to halt – and begin to reverse – the spread of HIV, we all need to do more, and do it faster. This change of pace has created challenges to keep the work of donors harmonised and to maintain quality control in rapidly expanding programming.
Funding arrangements are changing, both in terms of the scale of the funding and the impact that the funding has. The Global Fund and World Bank are both increasing their levels of funding for HIV, increasing possibilities in individual countries. However, this also raises issues about the capacity of countries to absorb and use this extra money, and the nature of the relationships between governments and civil society organisations themselves.
While new money means that civil society organisations can make a much larger contribution, it brings with it a greater risk of non-governmental and community-based organisations losing their ability to mobilise support and simply becoming implementing subcontractors. One way to avoid this is by having national intermediaries in each country, along the lines we set up when the Alliance was established.
More recently, anti-retroviral treatment has become increasingly available, and this has led to a shift in the general approach taken to programming. For example, there has been increased pressure for short-term results, sometimes at the expense of taking a capacity-building, developmental approach. The nature of HIV as a chronic emergency has increased the need for a dual approach: addressing immediate HIV-specific needs, while carrying out more long-term work on underlying factors and contexts.
Civil society needs to engage with and challenge the policies and programmes of other bodies, including government and health organisations, in the struggle against the epidemic.
