Two Longstanding Partners Seed a New Fund to Stem the Rise of HIV Transmission

The world was making real progress toward stamping out HIV/AIDS. The number of deaths had dropped by 68% since the peak in 2004, and the international community was marching toward a goal of eradication by 2022.

Then the pandemic hit.

Now, new data suggests that progress has stalled over the past two years, while already limited resources have been further strained by the need to address the fallout of COVID-19 and other global crises. It’s no surprise, then, that infection rates are on the rise.

In a challenging climate, two well-known partners in the HIV/AIDS fight have kept their eyes on the ball, and recently united to help break the cycle of HIV transmission. The Children’s Investment Fund (CIFF) committed $33 million toward the launch of a catalytic fund that will work to bring numbers down in up to five African countries. The Global Fund to Fight AIDS, Tuberculosis and Malaria, which created the fund, committed to matching CIFF’s support at a ratio of 1.5 to 1.

Here’s a look at the ways the two funds believe a focus on reducing the number of new infections can help end the disease, and some other philanthropies active in the fight.

A focus on prevention

The new fund focuses on prevention to decrease the number of new HIV infections. Peter Sands, executive director of the Global Fund, said, “While testing and treatment are essential tools in the fight against HIV, the ultimate goal is preventing transmission in the first place.”

Specifically, the commitment will support PrEP, short for pre-exposure prophylaxis. The medicine is highly effective when taken as prescribed, reducing the risk getting of HIV through sexual transmission by up to 99%. PrEP also successfully protects against infection by drug injection.

The fund will support all three forms of PrEP delivery — pill, vaginal ring or a shot — depending on in-country preferences.

Building on a partnership

The Global Fund and CIFF have been working together in the fight against HIV since 2015. Their partnership plays to the strengths of both organizations, combining CIFF’s readiness to innovate with the Global Fund’s expertise in HIV program support and scaling, relationships with country leadership, and proven track record managing public-private partnerships.

In 2019, the partners launched a $25 million catalytic fund to boost self-testing in places where millions were unaware of their status. That support reached five of the poorest countries in sub-Saharan Africa, and grew the number of available tests from a few thousand in 2019 to 3 million last year.

CIFF, which was co-founded in 2004 by U.K. activist investor Chris Hohn, describes itself as “the world’s largest philanthropy that focuses specifically on improving children’s lives.” That may not initially seem to draw an arrow to leadership on HIV funding — until you consider the consequences of transmission to women and to children. According to data assembled by UNAIDS, women and girls accounted for 49% of new HIV infections globally in 2021.

Miles Kemplay, executive director of sexual and reproductive health and rights at CIFF, said, “PrEP is one more tool that can bring us closer to the day where no baby is born with HIV, no adolescent girl is infected with HIV, and no child loses a parent to HIV. Preventing HIV protects the futures of children.”

CIFF’s new $33 million commitment to HIV is a full 30% higher than a previous commitment it made in 2019.

Other funders, other interventions

Several other big names in philanthropy have also stepped up to help wipe HIV/AIDS from the planet.

Among them is the Elton John AIDS Foundation (EJAF), which has battled the stigma and neglect that has kept AIDS alive since 1992. Its research, advocacy and activism work is need-based, and currently anchored in the ideas of creating urgency across stakeholders, changing perceptions and promoting the kind of dignity that lifts access to support. Since its founding, EJAF has raised more than $300 million for the fight.

Former President Bill Clinton established what’s now known as the Clinton Health Access Initiative (CHAI) in 2002 to help close the discrimination-driven gap in HIV treatment access. Once a Clinton Foundation program, CHAI has since grown into its own entity. Accomplishments include negotiating lower prices for lifesaving antiretroviral treatment (ARV), and working with governments to build the capacity for delivery. As a partial result of those efforts, the annual price of ARVs dropped from between $10,000 to $15,000 per person in 2000 to $140 per person in 2005. The dramatic decrease in costs inspired governments and other global actors to get off the sidelines, and is widely credited with helping to change the epidemic’s trajectory.

The Bill & Melinda Gates Foundation has invested more than $3 billion in grants to support global health organizations working in the hardest-hit countries of sub-Saharan Africa, with a focus on those that serve people with the highest risk of HIV, including adolescent girls and young women. To maximize impact, it also focuses on catalytic efforts, and has awarded an equal amount to the Global Fund.

Getting back on track

More than 40 years have passed since the first recorded case of HIV, and yet it’s still a major global public health problem. In 2020, an estimated 37.7 million people were living with HIV, and 680,000 people died of AIDS-related illnesses.

Back in 2015, the United Nations announced ambitious “90-90-90” global HIV treatment targets to end the epidemic by 2020. The three goals were for 90% of people living with HIV to know their status; 90% of people testing positive to begin antiretroviral therapy (ARV); and 90% of people receiving treatment to achieve viral suppression.

Between 2020 and 2021, the number of HIV infections dropped by only 3.6%, the lowest percentage since 2016. Places like Central Asia, Eastern Europe and the Middle East have all seen increases over the past several years, while numbers that were falling in Asia and the Pacific are on the rise.

Today, there’s a new effort to get back on track by 2030. Success will take a combination of political will, international cooperation, and a firm commitment to equity.

As Hohn put it, “Equal access to lifesaving products like PrEP is, tragically, not a given across the world. Catalytic investments at the right time, with organizations like the Global Fund, can change this, increasing the impact of philanthropic funds and saving millions of lives.”

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