Doing More With Less? Challenges and Opportunities for Funding the AIDS Response

2012 International AIDS Conference in Washington, DC; By Alessandra Nilo

Human ingenuity has proven throughout history that it can do more with less when absolutely necessary, inventing new ways of doing things, creating new tools and methods. Sometimes, it is a matter of survival. Among many innovative and ever- developing disciplines, process development, planning with creativity, and following through, stand out in establishing consistency that usually drives success.

UNAIDS now faces the challenge of creating new paths to mobilize resources to properly and optimally execute its fast track plans and meet the HIV-related goals within the Agenda 2030. The problem is, although UNAIDS has played a strategic role in responding to AIDS, donors have not responded equitably. The Joint Programme has seen its budget heavily reduced in the last two years, which creates extra stress in the execution of its mandate. As claimed by the Executive Director himself, this is a critical moment for the AIDS epidemic. “Invest now or run the risk of paying much more later,” means the situation may get worse than imagined or predicted in data charts. And we all know what the data says.

Despite the much praised commitment made to the AIDS-response funds, the fact is that the response has generally been underfunded since the beginning of the global financial crisis, which is now close to its tenth anniversary. Nevertheless, the extra effort made to reach tangible results accelerated the implementation of more access to ARTs. But to keep the reality check once again, we must remember that there are still millions of people without access to consistent treatment. Furthermore, millions of those who have access in low- and middle-income countries may experience unstable adherence to the medication due to lack of basic living conditions, such as nutritional security or resources for transportation to reach health services, which are just a few in a long list of identified barriers to access to treatment. In other words, both quantity and quality of existing services are still major issues.

AIDS is a challenge posed upon humanity on many levels, and it is still an exceptional one. Advances in the response is, first and foremost, a consequence of advocacy efforts spearheaded by key populations and affected communities, as well as dedicated people in the scientific field and passionate leaders within States and multilateral agencies. But history shows also that many governments, because of outdated moral values or claiming a competition of priorities, delayed strategic investment when it was needed in crucial moments of the epidemic. Even with commitment from UNAIDS, amplified with the Global Fund, PEPFAR, UNITAID, and the support from key developed countries that have kept their promises — voluntary Member-State financing suffered hard with the Great Recession. And let’s face it, funds have always lagged behind the demand imposed by the challenge. Even with so much investment in scientific and clinical developments, prevention (including information and education) and community responses have been de-prioritized, a strategic mistake that governments are finally beginning to realize.

2014 International AIDS Conference in Melbourne, Australia; By Malu Marin

Instead of replying to the call for doing more with less resources, long-term financial solutions is what we need for UNAIDS. We must secure a steady stream of resources as a strategic means of implementation, and not only rely on volatile voluntary donations from governments and a few large foundations, which is a highly concentrated funding model (ten donors are responsible for 86% of funds, with the US as the major donor.) We suggest developing concrete strategies to implement innovative financing mechanisms aligned with proper disbursement of funds for projects in strategic areas – including funds for CSO advocacy work – as a way to succeed. UNITAID, for instance, is a strong example of an innovative financing mechanism with steady stream that achieves tangible results.

There is one particular mechanism that has the potential of solving much of the financing for sustainable development paradigm, if it were implemented in a global scale. It is already proven that in its national implementation, taxing financial transactions (FTT) is a highly advantageous double-edged sword of revenue collection and capital markets regulation. Since 2012, France has adopted it, and 10 EU countries are negotiating a multi-jurisdictional treaty on FTTs. In 2016, the UK raised £2.8 billion on Stamp Duty on Shares and Securities. Brazil raises an average 30 billion Reals yearly on a broad FTT legal framework that ranges from securities to insurance contracts, including currency, credit, and gold trading. Contrary to orthodox liberal economics, FTTs have not distorted the capital markets in the countries where they exist, or where they have recently started operating.

In this regard, if UNAIDS starts looking at the global financial picture instead of only thinking about the traditional voluntary ways to fundraise, they will see that the world has become hyper-financialized. The amount of financial resources in the markets is enormous, compared to concrete economics of products and services. This condition of excessive financial liquidity has produced yet another boom in 2017. Though it is a concentrated financial bubble, it is an out-of-proportion revenue source that is not tapped into because of lack of political will from governments.

This is a consistent civil society demand that requires political courage and leadership to exercise sovereignty of States over Markets to benefit all, including the reluctant markets and their liberal pundits. For years, we have provided many concrete suggestions to UNAIDS. And now, after learning from sovereignty-based taxing instrumentality, there is a possibility of implementing an issue-tied model of agreement with one – or all – credit card issuers that can collect an AIDS-related token contribution from billions of users every month in the world. Or, an already tested approach amplified, could be the creation of a Product Red Credit Card that people may carry and frequently use, generating a stream.

Ideas like these are dependent upon the multiplicity of general economic behavior, whether consumption or financial operations. What is really necessary at this point for UNAIDS, is to establish mechanisms of consistent revenue collection that will bring onboard a critical mass of new donors. Such a campaign could also inform the world of the continued relevance of UNAIDS in the global AIDS architecture, properly communicating its values, results, and comparative advantage for contributions – a narrative still to be developed.

Therefore, we hope UNAIDS will consider the suggestions above. We reiterate that well-designed innovative funding mechanisms, including FTTs, can be a ‘clean’ way to turn idle and speculative capital into social development. Another way could be a token — taken from frequent revenue collection resulting from conspicuous consumption.

A stronger UNAIDS will also mean a stronger political capacity to better respond to challenges like these. Instead of backing down, “step up to the plate,” face up to the challenge, and explore the opportunities of the moment for long-term sustainability.

2012 International AIDS Conference in Washington, DC; by Malu Marin