Very few of the application to the Global Fund approved this week included substantial components that give medicine to people with AIDS. This has happened for two reasons:

1. The justifiable desire for a quick launch of the GF to get the money out the door quickly did not leave much time for developing countries to create new plans to initiate large scale access to Tx programs.

2. Stingy bilateral donors applied thumbscrews to developing countries to force them to ratchet down the size and scope of applications. people with AIDS are the casualty of this shameful effort to delay making meaningful contributions to the GF.

As TRP Chair Michel Kazatchine reported to the Board in open plenary, developing countries were "shy" about applying for ARV Tx, and believed that applications would be rejected if there were significant treatment components.

The technically rigorous review and accountability mechanisms in the successful applications are tremendous. However, most of what was funded is not very different from programs that are already supported by existing bilateral aid agencies.

The Board must become much more serious in the second round about ensuring the GF provides added value -- the "additionality" that Secretary General Annan is requesting. The GF must prioritize unfilled gaps. Overwhelmingly, this must mean treatment.

Until the GFATM puts pills in the hands of people with AIDS, it will not have fulfilled its mission.

Until the wealthy countries of the world stop putting impoverished nations in a vise to shrink the size of applications, then the mission of the fund is betrayed.

In the next request for proposals, The Global Fund Board must make clear that a country-level application that is lacking a significant AIDS treatment component does not pass muster. AIDS plans lacking medicine for the sick cannot by any means fulfill the "comprehensive, balanced" requirement in the mission of the Fund.

Insisting on treatment will be expensive. However, help is on the way.

On Wednesday this week, Senators Durbin and Specter began to correct the damage done by President Bush's relentless underfunding of the GF. These two powerful senators on the Appropriations Committee are going to include $700 million for the Global Fund in an emergency spending bill now before Congress.

When the leadership of Specter and Durbin is added to the efforts underway in the House _and_ the concurrent move to find $500 for MTCT by Senators Helms and Frist, it is definite that we will see a significant new contribution to the GFATM by June.

This is more important than ever because the GFATM is running low on resources, and will be bankrupt by year 2 even without new applications. The second round of applications will be much more comprehensive, and much more expensive. The treatment component must be prioritized, and this will raise total costs.

Activists support the passage of the full $700 million propsoed by Senators Specter and Durbin. This must happen in addition to the $500 being requested by Senators Helms and Frist to prevent mother-to-child transmission of HIV. Mr. Frist and Helms should expand the MTCT grants to allow the treatment of whole families, and at least some of the moneis from the Helms bill should be contributed to the Global Fund at a level commensurate with MTCT-related applications now and in the future.

This money will be available to the Global Fund in time for the second round of proposals later this year. Other countries must meet the challenge of Senators Durbin, Specter, Helms, and Frist and substantially increase their contributions to the Global Fund. The low rung set by President Bush last year is no longer an acceptable measure for other donors, and a failure to step up contributions demonstrates a lack of serious commitment.

Thank you for your time.

Paul Davis
pdavis@critpath.org
Health GAP Coalition
ACT UP Philadelphia

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