Having asked who should get the dosh, it would be useful to look back at who got it so far. For many years, the fight against HIV and AIDS was not a cause attracting a lot of financial attention within developed countries. It is not until the 2000 international AIDS conference in Durban that the issue of “universal access” to treatment and prevention and the creation of the Gates Foundation and the Multi-Country HIV/AIDS Program (MAP) that investment started to flow from rich to poor countries.

Before 1998, less than $500 million was invested annually by wealthy countries into fighting HIV in less fortunate countries. The Gates Foundation and MAP were soon followed by the creation of the Global Fund to fight HIV AIDS Tuberculosis and Malaria (2002) and PEPFAR (2003). Today, these four programmes contributes altogether to more than 70% of the global funding.

Not all developing countries are equal when it comes to receiving support, and it would be wishful thinking to believe that those most in need are those who receive most. There are many reasons why this is not happening.

First it depends on the country needs. Second it depends on what the fund is used for, prevention, treatment or both and this is not always a direct response to the country needs, but depends on the ties added to the funding source (PEPFAR being the best example). Third, it depends on a country’s capacity to implement a particular programme. For instance, investing heavily in providing treatment in a country where there is no infrastructure would be pointless. And last but not least, it depends on geopolitics and as Peter Piotr put it, “foreign aid is an extension of foreign policy.”

As a results, Myanmar, which has an HIV prevalence of 1.3% and where 360,000 people are living with HIV and AIDS (PLWHA), $40 have been disbursed per PLWHA. Compare this to South Africa which has a similar population, but an HIV prevalence of 3.7% and an estimated 5.5 millions PLWHA where $170 have been disbursed per PLWHA. This seems to make sense but then compare this to Rwanda, where $2015 have been disbursed for each of the 190,000 PLWHA (prevalence of 3.1%) and to Zimbabwe where a ludicrous $98 has been disbursed for each of the 1.7 millions Zimbabwean PLWHA!

This only describes where the money went. What the money did is altogether another and very different story.

(Source: Science July 25, 2008)

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