The Global Fund has pledged to re-energize HIV prevention and, in line with that commitment, civil society groups are calling on the Fund to offer more explicit data on how much it spends on these efforts. That includes not only overall expenditure data, but also granular information, like spending at a country level and spending on specific interventions.
In November 2016, Global Fund Executive Director Mark Dybul acknowledged in an article on the Fund's website that in the global effort to end the HIV epidemic, prevention efforts have lagged behind treatment, highlighting a rate of new infections among adults – 190,000 in 2015 – that has remained steady since 2010. And he vowed the Global Fund would increase its efforts.
“At the Global Fund, we are committed to doing more to boost HIV prevention efforts among all the people who have been left behind in HIV prevention,” he wrote. “We will work to accelerate access to comprehensive HIV services – including provision of combination prevention interventions – among key and vulnerable populations, and investing in people-centered and community-led responses.”
The problem, civil society groups say, is there is no way to know to what extent the Global Fund has or will ultimately contribute to these efforts. That makes it difficult to gauge the impact of the Global Fund’s expenditures and to help advocate for more money for the Fund.
“The Global Fund has initiated this new prevention focus reimagining prevention,” said Kevin Fisher, the policy director at AVAC, a global prevention advocacy organization. “It might all be going well. There's not really a way to know.”
As an example of what advocates are looking for, he pointed to the President’s Emergency Plan for AIDS Relief (PEPFAR) – the United States’ bilateral response to the HIV epidemic. PEPFAR provides detailed breakdowns of prevention expenditures on a national and even sub-national level.
Fisher suspects the reason the Global Fund does not provide more detailed information is that the Fund is dependent on implementing partners to provide this data, while PEPFAR runs its own programs. Global Fund representatives did not respond to a request for comment.
What is certain, Fisher said, is that the Global Fund provides critical financial support for prevention services. This includes money for safe male medical circumcision, targeted prevention interventions for key populations and an increased focus on prevention services for adolescent girls and young women.
These interventions are three of the five prevention pillars UNAIDS has underscored as critical to ending the AIDS epidemic by 2030 in line with its fast-track strategy. Along with country-level information, Fisher said advocates would welcome more details on how much the Global Fund is spending on each of these initiatives. This could be instrumental in leveraging additional money, both for the Global Fund, but also more generally – in line with UNAIDS’ call for strengthening the financial commitment to prevention.
“This would be helpful as we make the case that the Global Fund is doing tremendously important work in prevention” Fisher said. “We know that they are doing circumcision work. We know that they’re doing primary prevention for key populations.” To know how much the Fund is specifically spending on each “would be tremendously helpful.”
It would be helpful especially since advocating for additional money to allow the Global Fund to expand its prevention work could be more necessary than ever in a political landscape where it is uncertain to what extent the U.S. will maintain its role as a leader in the global HIV response.
Already, Fisher said, the Global Fund might be called on to provide more support to organizations who will see funding cuts after the Trump administration introduced an expanded global gag rule. The rule prevents organizations receiving U.S. funding for global health work from providing abortion services or discussing abortion as an option with clients. A service provider who declines to adhere to this restriction might soon be in search of other funding sources.
Fisher said there are also concerns about possible cuts to organizations that provide services to key populations, including sex workers and men who have sex with men.
“We don’t really know what the new administration's view on prevention services for key populations will be and whether it’s possible the Global Fund might have a bit more leeway in serving MSM or sex worker or other groups,” he said.
There are some indications of where the Global Fund’s money is going. In UNAIDS’ 2016 Prevention Gap Report, the agency acknowledged that while detailed expenditures from the Global Fund were not available, the Global Fund Secretariat did conduct a preliminary analysis for the publication that indicated 14% of the Fund’s expenditures in 2014 were on primary prevention.
Fisher said it might also be possible to go back to individual grant agreements to determine how much Global Fund money was allocated for prevention efforts, though that would not necessarily translate into expenditures.
Advocates have not made an explicit request to the Global Fund for this information, though the issue has been raised informally during discussions with officials there, Fisher said. He added that there are some recent developments that might be useful.
In June 2016, the Global Fund Board adopted new key performance indicators (KPIs) that include extending tracking of services for key populations to cover both treatment and prevention. Though the board approved the KPIs, it has yet to set targets.
Fisher cautioned that it is still unclear whether the Fund will make the data it gathers as part of the KPIs publicly available and, if it does, when that information will ultimately be released.