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AIDS control in China
Editorial
The Global Fund/John Rae
The Global Fund and a new modus operandi
See Comment page 1906 See World Report page 1907
For more on the Global Fund see http://www.theglobalfund.org/ en/board/meetings/twentyfifth
On Nov 21–22, the Global Fund to Fight AIDS, Tuberculosis and Malaria held its 25th Board meeting in Accra, Ghana. Tensions were high as the Fund had to make difficult decisions in a year that has been plagued by financial shortfalls, corruption, and calls for organisational reforms. In view of the financial challenges presented by the US budget environment and the Euro crisis, the Fund has now decided to cancel grant funding for round 11, which will be a huge setback to these disease programmes worldwide. However, the Fund remains committed to ensuring the continuation of essential services and to supporting existing grants over new ones to the end of 2013. Tougher rules will be introduced such as limiting of funding to some middle-income countries, which include Argentina, Brazil, China, Mexico, and Russia. This approach will ensure no programmes have to close. Gains in health outcomes will be protected. The next replenishment period will be for 2014–16 and will be shaped by a new 5-year strategy (2012–16) adopted by the board, which unlike previous strategies focuses on two goals: to save 10 million lives
and prevent 140–180 million new infections from HIV, tuberculosis, and malaria during that time. The board also approved a consolidated transformation plan that, alongside the new strategy, will provide a roadmap for the organisation’s transition from its present emergency response approach to one providing sustainable long-term funding for successful interventions. The plan will improve risk management, fiduciary controls, and governance of the organisation. This new funding model will ensure more strategic investments in the highest impact countries with increased engagement between partners and implementers. Next week marks the 10th anniversary of the Commission on Macroeconomics and Health, which entrenched the notion that health equals wealth. The Commission made a strong intellectual case for the creation of the Fund, which has turned out to be a lifeline for some of the world’s poorest people. Donors must not turn their backs on the Fund, no matter how hard the times. ■ The Lancet
Corbis
Political commitment for HIV/AIDS control in China
For the recent study on HIV mortality in China see Articles Lancet Infectious Diseases 2011; 11: 516–24 For more on Eastern Europe and central Asia’s HIV epidemic see http://www.unaids.org/en/ media/unaids/contentassets/ documents/unaidspublication /2011/JC2216_WorldAIDSday_ report_2011_en.pdf
1896
At a time of global budget crisis for HIV/AIDS funding, there is still some good news for people with the disease in China. Last month, in the plenary meeting of the State Council AIDS Working Committee, Chinese Vice Premier Li Keqiang vowed that China would substantially expand HIV/AIDS prevention and control coverage in the next 5 years, which means that free voluntary counselling and testing would be available in all hospitals at county level and above, as well as at grassroots clinics in regions with high HIV/AIDS prevalence. Additionally, access to effective interventions including condom use and methadone maintenance treatment is to be increased to at least 90% of people at high risk of HIV infection (such as sex workers and injecting drug users) by 2015. China’s present HIV prevalence rate of 0·06% might seem low, but the absolute size of the population means large numbers of people are infected with HIV. China’s Ministry of Health and UNAIDS estimate that by the end of 2011 there will be 780 000 people living with HIV/AIDS and 48 000 new infections in mainland China. “The epidemic is still on the rise in China…but at a slower
rate than before”, said Wu Zunyou, director of the National Centre for AIDS and Sexually Transmitted Diseases Control and Prevention. In 2008, HIV/AIDS overtook tuberculosis as the leading cause of death from an infectious disease in China. A national free antiretroviral treatment programme, as well as the first legislation directly aimed at controlling HIV/AIDS—the AIDS Prevention and Control Regulations—has been initiated by the Chinese Government. A recent study showed that overall HIVrelated mortality decreased from 39·3 per 100 personyears in 2002 to 14·2 per 100 person-years in 2009, with increasing coverage of antiretroviral treatment. The time has come for China to take a leadership role against HIV/AIDS within Asia. Strong and consistent political will from the highest level in HIV/AIDS control can not only benefit China, but also serve as a good model to neighbouring regions, such as central Asia. Eastern Europe and central Asia have had a staggering 250% increase in the number of people living with HIV/AIDS during the past decade. This urgent health crisis must be addressed. ■ The Lancet www.thelancet.com Vol 378 December 3, 2011
The Global Fund/John Rae
The Global Fund and a new modus operandi
See Comment page 1906 See World Report page 1907
For more on the Global Fund see http://www.theglobalfund.org/ en/board/meetings/twentyfifth
On Nov 21–22, the Global Fund to Fight AIDS, Tuberculosis and Malaria held its 25th Board meeting in Accra, Ghana. Tensions were high as the Fund had to make difficult decisions in a year that has been plagued by financial shortfalls, corruption, and calls for organisational reforms. In view of the financial challenges presented by the US budget environment and the Euro crisis, the Fund has now decided to cancel grant funding for round 11, which will be a huge setback to these disease programmes worldwide. However, the Fund remains committed to ensuring the continuation of essential services and to supporting existing grants over new ones to the end of 2013. Tougher rules will be introduced such as limiting of funding to some middle-income countries, which include Argentina, Brazil, China, Mexico, and Russia. This approach will ensure no programmes have to close. Gains in health outcomes will be protected. The next replenishment period will be for 2014–16 and will be shaped by a new 5-year strategy (2012–16) adopted by the board, which unlike previous strategies focuses on two goals: to save 10 million lives
and prevent 140–180 million new infections from HIV, tuberculosis, and malaria during that time. The board also approved a consolidated transformation plan that, alongside the new strategy, will provide a roadmap for the organisation’s transition from its present emergency response approach to one providing sustainable long-term funding for successful interventions. The plan will improve risk management, fiduciary controls, and governance of the organisation. This new funding model will ensure more strategic investments in the highest impact countries with increased engagement between partners and implementers. Next week marks the 10th anniversary of the Commission on Macroeconomics and Health, which entrenched the notion that health equals wealth. The Commission made a strong intellectual case for the creation of the Fund, which has turned out to be a lifeline for some of the world’s poorest people. Donors must not turn their backs on the Fund, no matter how hard the times. ■ The Lancet
Corbis
Political commitment for HIV/AIDS control in China
For the recent study on HIV mortality in China see Articles Lancet Infectious Diseases 2011; 11: 516–24 For more on Eastern Europe and central Asia’s HIV epidemic see http://www.unaids.org/en/ media/unaids/contentassets/ documents/unaidspublication /2011/JC2216_WorldAIDSday_ report_2011_en.pdf
1896
At a time of global budget crisis for HIV/AIDS funding, there is still some good news for people with the disease in China. Last month, in the plenary meeting of the State Council AIDS Working Committee, Chinese Vice Premier Li Keqiang vowed that China would substantially expand HIV/AIDS prevention and control coverage in the next 5 years, which means that free voluntary counselling and testing would be available in all hospitals at county level and above, as well as at grassroots clinics in regions with high HIV/AIDS prevalence. Additionally, access to effective interventions including condom use and methadone maintenance treatment is to be increased to at least 90% of people at high risk of HIV infection (such as sex workers and injecting drug users) by 2015. China’s present HIV prevalence rate of 0·06% might seem low, but the absolute size of the population means large numbers of people are infected with HIV. China’s Ministry of Health and UNAIDS estimate that by the end of 2011 there will be 780 000 people living with HIV/AIDS and 48 000 new infections in mainland China. “The epidemic is still on the rise in China…but at a slower
rate than before”, said Wu Zunyou, director of the National Centre for AIDS and Sexually Transmitted Diseases Control and Prevention. In 2008, HIV/AIDS overtook tuberculosis as the leading cause of death from an infectious disease in China. A national free antiretroviral treatment programme, as well as the first legislation directly aimed at controlling HIV/AIDS—the AIDS Prevention and Control Regulations—has been initiated by the Chinese Government. A recent study showed that overall HIVrelated mortality decreased from 39·3 per 100 personyears in 2002 to 14·2 per 100 person-years in 2009, with increasing coverage of antiretroviral treatment. The time has come for China to take a leadership role against HIV/AIDS within Asia. Strong and consistent political will from the highest level in HIV/AIDS control can not only benefit China, but also serve as a good model to neighbouring regions, such as central Asia. Eastern Europe and central Asia have had a staggering 250% increase in the number of people living with HIV/AIDS during the past decade. This urgent health crisis must be addressed. ■ The Lancet www.thelancet.com Vol 378 December 3, 2011