Global Fund Announces First Round of Grants, $378M to Go Toward 40 Programs in 31 Countries

The Global Fund to Fight AIDS, Tuberculosis and Malaria yesterday announced its first round of grants, awarding $378 million over two years to 40 programs in 31 countries, according to a fund release. The board, which concluded its second meeting yesterday at the Mailman School of Public Health at Columbia University, also "fast-track[ed]" approval for 18 other proposals that have requested $238 million, bringing the proposed funding total to $616 million over two years. More than 300 proposals were reviewed by the fund's Technical Review Panel, an independent committee of 17 experts in prevention, clinical care, health education and international development. Recommendations were made by the panel, and the fund's board took the final vote on the proposals. "We received far more proposals than we are able to fund in this first round, demonstrating how great the need is to address HIV/AIDS, tuberculosis and malaria. We prioritized high-quality proposals that were based on effective programs and lessons learned and were developed by partnerships of governments, community organizations, people living with the diseases and other groups," Dr. Anders Nordstrom, the fund's interim executive director, explained, adding, "We also prioritized proposals that clearly demonstrated how new resources from the global fund would fill funding gaps and achieve results." Dr. Chrispus Kiyonga, chair of the fund's board, added that the fund has "strong monitoring and evaluation procedures in place to ensure that the grant funds will be used properly and have a measurable impact."

The Breakdown
Programs in African nations received 52% of the total grants awarded, with 13% going to programs in the Americas, 8% to programs in Eastern Europe and Central Asia, 12% to programs in Southeast Asia and 14% to programs in the Western Pacific (Global Fund release, 4/25). Nations receiving the most money were South Africa with $25 million, Zambia with almost $20 million, China with $15 million and Zimbabwe and Haiti with $10 million apiece. Most of the grants will fund programs that incorporate a combination of prevention and treatment, and 21 of the 28 HIV/AIDS-specific grants "specifically include money to buy" antiretroviral drugs.

Treatment Pushed
HIV/AIDS treatment was among the more contentious issues at the meeting. Doctors Without Borders urged the fund to emphasize treatment over prevention, saying that "any diversion of money away from treatment is an act of cruelty to those with the virus." Brigitte Syamalevwe, an HIV-positive woman who is the Doctors Without Borders program director for Zambia, appealed to the board to "stop playing God" with respect to treatment, adding that those with the virus "have as much right to life as anyone" (Crary, AP/South Florida Sun-Sentinel, 4/25). Jim Yong Kim, one of the founders of Partners in Health, a Cambridge-based group running health projects in several nations, including an HIV/AIDS project in Haiti that received a grant from the fund, said the move to treat people with HIV/AIDS marks the "first time there has been a commitment that we shouldn't let people in Africa die when we had the drugs available to keep them alive." He added, "We are treating Africans as if they are really human beings." Economist Jeffrey Sachs said that the decision to pay for treatment was a breakthrough, but noted that the amount earmarked is "grossly inadequate" compared to the scale of the problem (Donnelly, Boston Globe, 4/26).

More Money
Dr. Paul Zeitz, head of the Global AIDS Alliance, said, "It's simply shocking that this highly effective initiative is still so underfinanced" and urged Congress to make an "emergency" $700 million contribution to the fund. The United States has already pledged $500 million to the fund, which so far has donations for about $2 billion, a level "far short" of U.N. Secretary-General Kofi Annan's goal of at least $7 billion annually (AP/South Florida Sun-Sentinel, 4/25). Richard Feachem, a professor of international health at the University of California who was appointed executive director of the fund at this week's board meeting, said that the fund's success will breed more support. "The greatest threat to the global fund is failure to demonstrate impact. Everything hinges on successful investments that deliver the goods" (Brown, Washington Post, 4/26). A list of grant recipients is available online on the fund's Web site.