The Beginning of the End: Tracking Global Commitments on AIDS

"If the global community is serious about achieving the beginning of the end of AIDS, there must be a renewed effort to examine, improve and scale up the financial, political and programmatic efforts needed to turn vision into action."

In this report for World AIDS Day, December 1 2012, the organisation ONE monitors recent progress on improving access to HIV/AIDS treatment and reducing new HIV infections; provides an assessment of the G7 countries’ and the European Commission’s past and current efforts in the fight against HIV/AIDS globally; and sets a baseline for monitoring future progress towards the beginning of the end of AIDS. ONE is a web-based effort of 3 million members dedicated to the fight against extreme economic poverty through advocacy. (Click here to access the AIDS advocacy campaign website.) It works through informing members and, particularly, donors from and including developing countries about indicators of extreme economic poverty and the consequences, like the HIV/AIDS epidemic, and production of information on behalf of the 1 billion people living in conditions resulting from economic poverty. With this report, ONE intends to influence donors to seek closer partnership with each other and with African governments, emerging economy governments, the private sector, and civil society groups to leverage unique skill-sets and resources, all aimed towards the achievement of common target goals. The document emphasises the funding gap that, according to the report, is one of the largest hurdles for leaders from the scientific, political, and advocacy communities who have made calls for achieving "the beginning of the end of AIDS" or an "AIDS-free generation".

The report graphs disease-specific indicators, including new HIV cases among adolescents and children, statistics on prevention of mother-to-child transmission (PMTCT), and numbers of people receiving anti-retroviral (ARV) treatments. It focuses onseveral donor countries and their responses to the epidemic, particularly in the 22 high-burden countries. Some communication aspects of those responses, including advocacy, participation with locally-run programmes, and monitoring and evaluation, are exemplified by the following:

• "CIDA [Canadian International Development Agency] makes efforts to align with the principles of aid effectiveness, placing an emphasis on local country ownership and promoting national leadership in the development of HIV/AIDS policies and strategies, based on locally identified needs and priorities."
• "In 2010, the European Commission leveraged the International AIDS Conference in Vienna to host a number of side sessions and highlighted projects funded through the European Health Programme."
• "The AIDS chapter in France’s sectoral strategy states that it closely links the fight against AIDS to human rights: fighting against stigma and discrimination, allowing for universal health access, targeting protection for populations at risk and protecting young girls against sexual exploitation and rape."
• "German bilateral priorities include tailoring prevention strategies to match the epidemiological and social context of each country; advancing gender equality; optimising financial resources available in-country; and scaling up social protection services."
• "As part of JICA [Japan International Cooperation Agency]’s strategy, it committed to rigorous monitoring and evaluation of its assistance in the health sector. Among other efforts, JICA committed to undertaking quantitative reviews of the outcomes and impacts achieved by its investments in order to validate the effectiveness of capacity development in improving health outcomes."
• "Specifically, DFID [Department for International Development- United Kingdom] has committed itself to better tailoring its prevention efforts to localised epidemics and to scaling up evidence-based prevention approaches, with an emphasis on PMTCT, voluntary medical male circumcision, TB prevention and diagnosis, family planning and harm reduction."
• Along with its PMTC efforts, the United States "has also made a quiet but noticeable programmatic shift in its HIV prevention strategies, moving from the ABC paradigm (abstinence, be faithful, consistent and correct use of condoms) to the combination prevention paradigm (with special emphasis on treatment as prevention, voluntary medical male circumcision and prevention of mother-to-child transmission of HIV)."

The case studies highlight "non-traditional actors to combat the AIDS pandemic", including those from emerging economies, the private sector, and non-governmental organisations (NGOs), including faith-based actors. Some examples follow:

• South-South cooperation: "Brazil also provides support to other developing countries through its International Centre for Technical Cooperation (ICTC) on HIV/AIDS, established in 2005 in partnership with the UN.9 In 2010/11, the ICTC undertook 14 collaboration projects, including in Congo, Guinea-Bissau, Kenya, Tanzania and Zambia. Like Brazil’s international cooperation programme more broadly, the ICTC takes a ‘horizontal’ rather than a 'topdown' approach, facilitating efforts by emerging countries to exchange experiences, learn together and share results and responsibilities."
• Private businesses: Private firms in South Africa are instituting workforce testing and treatment to protect employees. Coca Cola in Tanzania is partnering with NGOs to institute "last mile" drug distribution. (RED) is a business model intended to transform the collective power of consumers through an initiative of corporate brand promotion linked to the contribution of a percentage of profits to the Global Fund. 
• NGOs: The Center for Interfaith is committed to promoting "behavior change through health, education, and other development initiatives" through faith leaders. Prévention Informati on Lutte contre le Sida (PILS) in Mauritius has advocated for decriminalisation of drug paraphernalia to enable such programmes as needle exchange, along with support groups for drug injecting populations at high risk of contracting HIV. A religious group in California, US, has, in five years, expanded a group of 30 trainee community health workers to more than 3,500 in Rwanda; and, by the end of 2012, there will be 7,000. "What makes this approach unique is that it is owned and managed by the local churches, and volunteers are not given any fee for attending the training or a stipend for their work."

Among the efforts needed, as listed in the concluding segment of the report, are the following:

1. Target One - Elimination of mother-to-child transmission: Implement and monitor the PMTCT plans of the 22 high-burden countries beginning with refocusing their political will and national strategies. Link the reproductive and maternal health communities to the efforts of PMTCT so that women can plan pregnancies and, through strengthened health systems, readily access the appropriate testing and counselling and continuum of care for themselves and their babies throughout pregnancy, labour, delivery, and breastfeeding.
2. Target Two - Ensuring access to treatment for HIV-positive individuals: Scale up health services through: training and retaining additional health-care workers; improving access to testing, counselling, and care; and better integrating these efforts with other global health programmes already in place.
3. Target Three - Reduction of new adolescent and adult HIV infections: "When combined with PMTCT strategies, condom distribution, and ongoing behaviour change education programmes, HIV transmission can be significantly reduced in the future through what UNAIDS calls a 'prevention revolution'." Steps include: improve mapping of drivers of the infection within key populations, communities, countries, and regions; tailor combination prevention strategies to specific epidemics; and support a robust research and development agenda for new prevention technologies.