Demands on the Global Fund are growing The funding squeeze affecting the Global Fund and the (U.S.) President's Emergency Plan for AIDS Relief (PEPFAR), which together provide treatment for eight out of every ten people on antiretrovirals, means reduced availability for HIV programmes in low-income countries with high HIV burdens. These countries will be unable to fund the necessary HIV interventions on domestic funds only, even with increased allocation for health budgets. These are some of the observations of "Getting Ahead of the Wave: Lessons for the Next Decade of the AIDS Response," a report produced by Medécins Sans Frontières (MSF). The report points out that the Global Fund is facing a several billion dollar shortfall because of insufficient donor pledges at its 2010 replenishment conference; and that, for the first time in its history, no new funding round will be approved in 2011. The report adds that in Round 10, in 2010, more than half of the HIV proposals were rejected; and that the affected countries will now have to wait until 2012 for decisions on new proposals, with funding likely to be available only in 2013. According to the report, more demand is being put on the Global Fund to fill in as other funders, such as World Bank and UNITAID, end some of their programmes. (UNITAID is an international facility for the purchase of drugs for HIV, TB and malaria. The report said that the World Bank and UNITAID will end paediatric care funding in 2011.) As result, MSF said, some countries with high HIV burdens are reducing ambitions to scale up treatment and putting on hold plans to implement new, improved World Health Organisation (WHO) recommendations for better and earlier treatment. The report said that the situation is particularly difficult in countries like the Democratic Republic of Congo which have had HIV proposals to the Global Fund rejected in successive rounds. The MSF report is available on the MSF website here. Editor's note: Three countries have had their HIV proposals to the Global Fund rejected in each of the last three rounds (Rounds 8, 9 and 10): Brazil, Sudan South and Yemen. Another 11 countries have had HIV proposals rejected in both Rounds 9 and 10: Botswana, Chad, Democratic Republic of Congo, Dominican Republic, Ethiopia, Guinea Bissau, Moldova, Mongolia, Niger, Togo and Uganda. Three countries had HIV proposals rejected in Rounds 8 and 10 (and did not apply for HIV in Round 9): Armenia, Namibia and Swaziland. Two countries had HIV proposals rejected in Rounds 8 and 9 (and did not apply for HIV in Round 10): North Korea and Pakistan.