Key groups in anti-AIDS fight aim for unity

ADDIS ABABA, Ethiopia -- In the politics of the global fight against AIDS, the top players had an extraordinarily difficult time trying to work together at first. They battled over strategy. They competed for recognition.

But now those battles from the last two years are in great part fading away. With several programs of the Global Fund to Fight AIDS, Tuberculosis, and Malaria now in danger of collapsing, in large part because recipient governments are not spending the money, the US global AIDS effort has offered its political muscle and organizational abilities to help save the initiatives.

These developments, which have come to light this week at the second annual meeting of field workers for the President's Emergency Plan for AIDS Relief, have spurred hopes the world's two largest AIDS funding organizations can strengthen their alliance.

The potential for increased cooperation raises the possibility of finding more efficient ways to save lives in a pandemic with an estimated 40 million people infected by the deadly virus, two-thirds of them in sub-Saharan Africa.

AIDS activists have long charged that the US government wanted to undercut the Global Fund by not giving it more money -- the US accounts for one-third of donations -- but a Global Fund official said yesterday ''the opposite was true."

''The relationship has changed dramatically," W. Brad Herbert, the Global Fund's chief of operations, said in an interview at the meeting. ''It's been a learning curve for everybody. If donors think that a Global Fund staff of 150 people in Geneva will monitor programs around the world, we will fail. We need a different model" with AIDS specialists in several countries helping to oversee Global Fund programs.

For overworked US government AIDS workers in the field, the worries are twofold: If Global Fund programs shut down, that would set back the battle against AIDS in those countries; then there are the doubts and confusion about how this new relationship would work.

After officials of the President's Emergency Plan told 180 US AIDS specialists at the meeting about the possibility of a closer collaboration, Kevin DeCock, a Centers for Disease Control and Prevention official based in Kenya, said the potential for failure ''troubles me deeply."

''If some Global Fund programs are failing, it would be disastrous for everyone," DeCock said. ''But we have no influence over the Global Fund or over the groups that receive their money. One of the reasons that PEPFAR is working on the ground is coordination of activities."

US global AIDS coordinators said they were still trying to figure out what the coordination would entail, but stressed that such crossover help may become essential in some countries. At the meeting, officials specifically talked about Global Fund programs in Tanzania and Kenya as experiencing difficulties. In both countries, the governments have spent just a fraction of tens of millions of dollars in AIDS money.

The new cooperation among the global AIDS players -- they also include UNAIDS and the World Health Organization -- can be traced to an agreement a year ago called the ''Three Ones." The deal, among the organizations, called for each country to develop one national policy, one coordinating body, and one monitoring system.

The Global Fund's troubled programs were discussed during a broader review here of the performance of the US efforts in AIDS prevention, care, and treatment. The United States is providing 54 percent of all donor funds to combat AIDS globally, totaling nearly $3 billion in programs in more than 100 countries. The programs are largely focused in 15 countries, 12 in Africa, plus Guyana, Haiti, and Vietnam.

The US participants cited several successes in their programs, including a 300 percent increase in treatment for AIDS patients in Kenya in the last year; a new record-keeping program using cellphone text messages in Rwanda; and a door-to-door AIDS testing program in Uganda that has a 94 percent acceptance rate.

But the AIDS workers also mentioned many challenges, including poor coordination in countries among donors. One of the biggest concerns is the lack of an international purchasing plan for medicines and materials. Officials said that such a coordinated plan would save money and ensure the delivery of drugs and other supplies. In the last year, some countries experienced drug shortages for AIDS patients.

Mark Dybul, deputy coordinator for the US global AIDS program, said in an interview yesterday that the United States had strong interest in making sure that Global Fund programs succeeded, saying the organization was ''so important in fighting AIDS around the world."

Dybul also said that the Global Fund ''unquestionably needs more money." He said the most pressing problem at the moment in some countries, though, was getting existing programs moving.

Herbert, the Global Fund official, said he has delivered warnings to countries that if they don't spend the money that they've already received from the Global Fund soon, ''they are going to lose it."

John Donnelly can be reached at donnelly@globe.com