Almost a thousand Swazi and South African HIV activists marched to the United States consulate in Johannesburg on 22 March 2012 to demand that the US continue supporting the Global Fund to Fight AIDS, Tuberculosis (TB) and Malaria, and safeguard funding of its President's Emergency Plan for AIDS Relief (PEPFAR), which US President Barack Obama's latest proposed budget will cut by 12 percent.
The march organizers - a coalition of international and regional HIV organizations, including the global medical charity, Médecins Sans Frontières (MSF), the World AIDS Campaign, and the AIDS Rights Alliance Southern Africa - also called on the British and Australian governments to join their American counterparts in kick-starting a response to solve the Global Fund's financial crisis.
Without an emergency donor meeting, the Fund - already in need of at least US$ 2 billion - will only secure additional funding at its next scheduled replenishment in 2014.
"We're not asking for charity, we are asking for social justice," said Daygan Eagar, a researcher at the South African human rights organization, Section27. "The US spends more money in one day of war than we're asking for the Global Fund."
Representatives from MSF, Section27 and the South African AIDS lobby group, Treatment Action Campaign, were to meet with consular and PEPFAR representatives to discuss their concerns.
The demonstration was also endorsed by the two million-member Congress of South African Trade Unions (COSATU). It followed similar protest action at US representative offices in Swaziland, according to Siphiwe Hlophe, a founder of the NGO, Swaziland for Positive Living (SWAPOL).
"If we are here, if we are laughing, it is because we are on drugs," she told the crowd. "Before the Global Fund we didn't have food, we didn't have pyschosocial support, we didn't disclose our HIV status - that all started when the Global Fund came. Look at how many of us are here today - that is the Global Fund."
Countries cap HIV treatment programmes
The Global Fund and PEPFAR provide financial resources for 84 percent of all HIV treatment in developing countries, but in November 2011 the Global Fund cancelled its next round of funding after donors failed to deliver US$2.2 billion of previously committed funding.
Emergency measures, such as a Transitional Funding Mechanism (TFM), have been put in place for some countries, but as they scramble to submit TFM applications by the 31 March 2012 deadline, some have said the money may only be disbursed in early 2013.
In the meantime, countries are already struggling to deal with the consequences of Round 11 being cancelled and shortfalls at the Fund, including HIV treatment shortages for adults and children. National campaigns to increase access to better HIV drugs and prevention of mother-to-child transmission (PMTCT) of HIV services have been stopped in their tracks, according to a new MSF briefing, "Losing Ground".
The 12-page report shows that countries such as the Democratic Republic of Congo (DRC) Guinea and Myanmar are already capping the number of people who can receive antiretroviral (ARV) treatment, while Uganda will be unable to increase the number of people initiated on ARVs annually.
Mothers and children are also losing, according to the report, which says that plans to increase the number of health facilities providing PMTCT in the DRC and Malawi have been jeopardized by the cancellation of Round 11, as have plans to move to better treatment in Malawi, Zimbabwe and Mozambique.
With less access to PMTCT, countries like DRC will probably see an increase in the number of babies born HIV-positive, but the money to treat HIV-positive children is also shrinking. The report cites multiple examples of paediatric HIV treatment programmes drawing to an end in countries that are heavily dependent on UNITAID funding, like Swaziland, Uganda and Zimbabwe. In a time of dwindling health donors, the Global Fund may be the only alternative resource for these programmes.
In addition to an emergency Global Fund donor meeting and replenishment, the report recommends that countries adopt innovative funding mechanisms like financial transaction taxes to support HIV care and treatment.
Countries should also ensure that they make the most of TRIPS flexibilities - the World Trade Organization's Trade Related Aspects of Intellectual Property Rights (TRIPS), which allows countries to override patents for public health purposes by issuing "compulsory licenses" that enable the generic manufacture of drugs still under patent - so as to access medicines at the lowest possible cost.