“We Should Strive to Eliminate HIV infections among Injection Drug Users by 2015” – Kazatchkine

Author:

David Garmaise

Article Type:

Article Number: 2

ABSTRACT In his latest progress report to the Board, Executive Director Michel Kazatchkine said that the international community should set a goal to virtually eliminate HIV infections among injection drug users by 2015. Kazatchkine also provided updates on a number of other issues, including community systems strengthening, grant performance and prevention of mother-to-child transmission.

E.D. updates the Global Fund Board on many topics

Michel Kazatchkine, Executive Director of the Global Fund, says that “if we are to end the AIDS epidemic, we must begin to see a dramatic decline in new infections among people who inject drugs.” He added that the international community should set a goal to virtually eliminate HIV infections in this population by 2015.

Kazatchkine said that people who use illicit drugs are denied harm reduction services, have poor

access to antiretroviral therapy (ART), and are sometimes abused or tortured by law enforcement officials. “More high-level advocacy is needed to overcome the political, legal and sociocultural obstacles to providing appropriate interventions for drug-users,” Kazatchkine said. For this reason, he said, he has accepted an invitation to be a Commissioner on the Global Commission on Drug Policy, which will meet in early 2011.

This information is contained in an update that Kazatchkine prepared for the Global Fund Board meeting in December 2010. The update touched on many topics. We provide some highlights below.

Male circumcision: Although male circumcision is being implemented as a preventive intervention in a number of high-burden countries – including Botswana, Kenya, Tanzania, Zambia and Zimbabwe – uptake remains relatively limited. The Secretariat intends to undertake an analysis of Round 10 proposals and work with partners to find opportunities for scale-up.

Community systems strengthening (CSS): In Round 10, 49% of submitted proposals included a CSS component. More than 5% of the funds requested for Round 10 were earmarked for CSS.

Prevention of mother-to-child transmission (PMTCT): The initiative to improve the quality and coverage of PMTCT interventions, launched about 16 months ago, has resulted in reprogramming of over $70 million in existing HIV grants in 11 of the 20 countries that account for 80% of the global burden of vertical HIV transmission. Funds for PMTCT in Global Fund grants have risen by 65% in 2010.

PR breakout: As of November 2010, governments accounted for around two-thirds of the principal recipients (PRs), the non-government sector nearly 25%, and multilateral organisations (mainly UNDP) nearly 10%.

Grant performance: As of November 2010, 22% of grants were performing poorly (a B2 or C rating), and 52% of grants that had been performing poorly at the end of 2009 had improved their performance.

Grant signings: As of mid-November 2010, 94 Round 9 grant agreements had been signed, of which nearly half were single stream. Eight grants with a November 2010 deadline have received an extension. The Fund expects that agreements for the 40 grants with a February 2011 deadline will be signed on schedule. Of the 74 grants approved for Phase 2 in 2010, 44% were given a “Go,” 53% a “Conditional Go,” and 3% (two grants) a “No Go.” There has been a higher proportion of “Conditional Go” decisions and B2-rated grants at Phase 2 review in 2010, compared to 2009.

Single stream: As of mid-November 2010, the Global Fund projected that 60 single stream grant agreements would be in place by the end of 2010, and that another 60 will be signed in 2011.

Additional Safeguard Policy (ASP): ASP measures for Cuba were lifted in October 2010. Iran, Sudan (northern and southern sectors), Chad, Zimbabwe, North Korea and Haiti remain under the ASP. Mali, Mauritania, Djibouti, Côte d’Ivoire and Papua New Guinea are being added to the list of ASP countries as a result of recent OIG investigations. In addition, ASP measures are applied de facto to grants in Iraq, Syria and West Bank & Gaza.

LFA terms of reference (ToR): The Secretariat is revising the LFA ToR to strengthen the LFA role in detecting and preventing fraud and financial abuse. Also, issues related to fraud and financial abuse are now addressed in LFA training, and an updated LFA Manual will be published in early 2011. As well, LFAs are now required to conduct an assessment of fraud and corruption risks in all countries managed under the new Country Team Approach.

Additional comments

In his update to the Board, Kazatchkine expressed some opinions concerning (a) eligibility for funding, and (b) the proposal development process. With respect to the former, Kazatchkine said that if the Global Fund is to remain truly global in nature, eligibility criteria should not be based on considerations about the funding available at any given point in time. Instead, he suggested, consideration could be given to making eligibility contingent upon countries agreeing to co-finance programmes and having an agreed “exit” strategy in place, or countries becoming a contributor to the Global Fund in addition to being a grant recipient.

Concerning proposal development, Kazatchkine said that more effort is needed to better align the proposal development and grant negotiation processes – for example, by involving PRs earlier, by increasing the use of independent budget reviews by the TRP, and by designing incentives for implementers to sign grants in a timely manner.

Information for this article was taken from the “Report of the Executive Director,” December 2010, Document GF/B22/03 at www.theglobalfund.org/en/board/meetings/twentysecond/documents.