A panel meeting at the United Nations General Assembly High-Level Meeting on Ending AIDS, being held from 8 to 10 June, warned that the global commitment to end AIDS as a public health threat by 2030 cannot be met without increased funding, more efficiency and improved programme effectiveness.

Members of the panel, which met on 8 June and was entitled “Financing the end of AIDS: the window of opportunity,” argued that greater investment in the AIDS response needs to be front-loaded in the next five years and reach the US$ 26.2 billion needed by 2020 in low- and middle-income countries. Governments and development partners must increase their investments to close the nearly US$ 7 billion gap between the resources available for HIV in 2014 and the 2020 peak. This will avoid a looming funding crisis for treatment and prevention. 

According to the gathering’s political leaders, experts and representatives of international organizations and civil society, this extra funding will allow the world to meet the 2020 interim targets on the road to ending the epidemic. These targets include the 90–90–90 treatment target of 90% of people living with HIV knowing their status, 90% of people who know their HIV-positive status accessing treatment and 90% of people on treatment having a suppressed viral load, reducing new HIV infections to fewer than 500 000 and elimination of HIV-related discrimination.

It was argued that the AIDS response must spend increased funding wisely by adopting the Fast-Track approach of rapidly scaling up treatment and prevention services with more efficient and effective programmes. The panel also discussed mechanisms to facilitate development partners and low- and middle-income countries front-loading resources to reach the ultimate goal of ending the AIDS epidemic as a public health threat by 2030.

Beyond the call for more funding and better allocation of existing resources, other critical factors for the sustainability of the response were highlighted, including local production of antiretroviral medicines in Africa, improvement in the procurement of commodities through price negotiations and access and affordability of modern pharmaceuticals in all countries.

There was a strong call for the following: facilitating the transition of countries moving into higher-income brackets, including supporting community-based programmes; fully funding the needs of gay men and other men who have sex with men, people who inject drugs, sex workers, transgender people and prisoners, and particularly young people among those populations; investing in communities; and scaling up public–private partnerships.

The panel stressed forcefully that the cost of inaction for individuals, communities, countries and regions was simply too high and that the world could not afford to miss this window of opportunity to make funding sustainable and reinvigorate the HIV response over the next five years. 

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Now a 19-year-old university student in South Africa, Noxolo Myeketsi started receiving a social welfare grant in 2005. Part of a state-run programme to assist poor households, the cash transfers allowed her to stay in school and her grandmother to buy food and pay their bills.

The grant changed Noxolo’s life for the better. Other girls turned to having sex, often with older men, in exchange for basic needs, and potentially exposed themselves to sexually transmitted infections and HIV.

“I believe that without the grant assistance, I would not have been able to make healthy decisions in my life. Maybe I would have ended up being a sugar daddy’s girl, like others from my area, or ended up contracting HIV,” Noxolo said.

Social protection schemes, including financial incentives, can make a difference in a number of ways. The World Bank reports that, globally, there is strong evidence that cash transfers improve the education, health and lifelong income of beneficiaries. 

“Cash transfer programmes work for HIV prevention and a host of other human development outcomes as well, and they are scalable,” said David Wilson, Director of the World Bank’s Global HIV/AIDS Program.

Studies conducted in South Africa show that small cash grants provided to poor households allow teenage girls to make safer sexual choices and can significantly reduce the number of new HIV infections. When psychosocial care and support are added to the cash, the results for girls are even better.

At the UNAIDS Programme Coordinating Board (PCB) meeting held in Geneva in July a thematic session was organized on addressing the social economic drivers of HIV through social protection, at which Noxolo spoke about the positive impact grants can have.

Following up on the PCB meeting, UNAIDS and the World Bank pledged to assist governments in the process of scaling up social protection programmes, including cash transfers, for HIV prevention in eastern and southern Africa, covering Botswana, Kenya, Lesotho, Malawi, South Africa, Swaziland, United Republic of Tanzania and Zambia.

“It is befitting that South Africa is the centre of the initiative because the country accounts for 23% of sub-Saharan Africa’s new HIV infections, 18% of the global HIV burden and has one of the world largest social protection programmes,” said Benjamin Ali, UNAIDS Country Director for South Africa.

Countries and partners will be urged to collaborate in a comprehensive review of social protection systems. Proposals to make such systems HIV sensitive include modifying age bands and other inclusion criteria to ensure that the groups most affected and at risk of HIV infection are covered, providing some cash directly to girls and young women and linking cash incentives to their adherence to HIV prevention and treatment programmes.