This article is part of a series on global AIDS issues to be published
by Rewire throughout December.  To find other articles in this series, search "global AIDS 2009." 

Significant progress has been made towards achieving
universal access to HIV prevention, treatment, care and support for people
living with and affected by HIV and AIDS. This progress is documented in
reports by the World Health Organization,
the U.S. President’s Emergency Plan for AIDS Relief,
the Global Fund to Fight AIDS, Tuberculosis and Malaria,
and in many journals and media outlets.

However, over the last few years,
instead of praising these achievements and reflecting on how we can use the
model of AIDS treatment for other diseases, we have seen a “backlash” against
the enormous efforts and in particular, the funding devoted to global AIDS. Numerous
media and journal articles portray these life-saving efforts and the funding
attached as culprits for the lack in major progress to reach other important MDGs
– primarily MDG 4 (reduce child mortality) and MDG 5 (improve maternal health). Some articles go as far as to blame global AIDS funding and programs as a main
reason that health systems remain inadequate and ill-equipped to manage the
various health needs and crises of populations in developing countries.
These analyses, however, fail to include the impact of World Bank-led health
sector reform in the 1980s and 1990s and its contribution to the current
situation.

The backlash
on global AIDS has been exacerbated by the economic crisis and played out in
funding priorities of donors. For example, the UK government’s HIV/AIDS
strategy launched in summer 2008 focused on strengthening health systems with
no specific funding target for HIV/AIDS.  The Italian government has announced that it will cut its Official Development
Assistance (ODA) budget (i.e. foreign aid budget) by 510 million euros between
2009 and 2011. Other major
European donors to the Global Fund such as the Netherlands and France are
seriously considering cutting their contributions. 
Finally, worrying signs from the US government point to the likelihood that
President Obama will not support an expansion of PEPFAR in FY2011 despite
bipartisan legislation authorizing the next five years of PEPFAR (FY2009-2013) at
$48 billion—of which $39 billion is slated for AIDS, $4 billion for TB and $5
billion for malaria. A World AIDS Day 2009 document released on the PEPFAR
website stated a greater emphasis on health systems strengthening, “From
FY 2010 onward, PEPFAR will report on partner countries’ national achievements
in service delivery and health systems strengthening, as well as PEPFAR direct
contributions to those achievements.”

While AIDS activists fight for commitments to be honored and
funding increased to continue the progress towards universal access commitments,
reproductive, maternal, newborn and child health advocates fight for donors to
put their money where their mouths are. To date, despite all the rhetoric by
donors that more needs to be done to get MDGs 4 and 5 back on track, little money
has been committed to the cause.

At the end of the day, funding devoted to AIDS and to other
diseases and health conditions are, in many instances, targeting the same
people. The MDGs should be viewed as a framework to work towards but not the
end in itself. We should not allow donors to swing the pendulum from one health
priority to another. Rather, we need to call on the US and other donors to
increase overall global health spending in a sustained and long-term approach that
does not pit one disease against another or the success of one program to the
detriment of another.