Will a new funding strategy leave behind HIV’s most vulnerable?

This year, World AIDS Day might be best spent reflecting on how we can make sure that socially excluded groups don’t get left behind in the global HIV response.

The Global Fund to Fight AIDS, TB, and Malaria is allocating $12 billion from donors to address the three diseases. The tricky part? How to spend it wisely. The dynamics of HIV are changing, and our approach to financing the response must change with it. It’s important that we reflect and make adjustments in real time if our funding strategies aren’t keeping up.

In March, the Global Fund did something that, on the surface, sounds logical: it approved a new funding model that prioritizes the poorest countries with the highest levels of disease. Countries with little money but lots of people living with HIV would get the biggest share of the funding, while countries with higher income and fewer people living with HIV would get less.

Makes sense, right? Actually, there are two problems here.

The first is that the best way to turn the tide of HIV may not necessarily be as simple as targeting the largest number of people. And the second is that the poorest people on the planet do not necessarily live in the world’s poorest countries.

Let’s start with the first problem. The Global Fund’s new funding model goes for sheer volume, targeting countries that have the most people living with HIV. But there are countries that have low overall HIV prevalence rates across the general population, yet suffer from devastating, highly concentrated epidemics within specific groups—for example, among people who use drugs, sex workers, or men who have sex with men.

Targeting these smaller epidemics is crucial, especially because members of these groups often can’t easily access HIV treatment and services. People who use drugs, sex workers, and men who have sex with men may face imprisonment simply for the work they do, for who they love, or for the substances they use. They don’t necessarily think of the health system as a place of support. Simply accessing health care can risk exposing them to the criminal justice system.

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