On World Aids Day 10 years ago, as I was preparing to leave office, the world was only beginning to grasp the severity of the Aids crisis. Nearly 36 million men, women and children were living with the disease, but only about 200,000 were receiving the treatment they needed. Funding was nowhere near the levels needed to prevent the disease from reaching pandemic levels.
Over the last decade, we have seen dramatic progress in both treatment and funding. In 2008 alone, $15bn was invested to fight Aids in developing countries, up from $6bn just three years earlier, due in large part to the US Government's PEPFAR (President's Emergency Plan for Aids Relief) programme.
This summer, I witnessed one of the greatest examples of this progress when I attended the World Cup in South Africa, which has the largest number of people living with HIV/Aids in the world. For too long, the South African government did too little, but this year, it committed to testing tens of millions of South Africans and to more than double the numbers on treatment. I'm honoured that they have invited the Clinton Health Access Initiative to work alongside them to reach this goal.
South Africa's new actions reflect a sense of urgency and shared purpose in Africa, and in other parts of the world, that didn't exist 10 years ago. Donor nations, the Global Fund to Fight Aids, TB and Malaria, and non-governmental organisations, including the Elton John Aids Foundation, the Gates Foundation, and many others, have provided indispensable contributions to raising consciousness, concern, and commitment to a level that will save millions of lives.
In spite of these efforts, only one-third of people who need treatment are receiving it. We risk losing our momentum, unless we find new ways to fill the gaps left by reductions in government funding caused by the global economic crisis. And we need to save more lives with the money we do have.
The most promising way to raise more funds is through very large numbers of small contributions which can be made in user-friendly ways. For example, France raises a lot of money every year from a service fee on airline tickets.
The amounts raised provide much of the funding for the International Drug Purchase Facility (UNITAID,) which buys medicines to treat Aids and other diseases in poor countries. We are now trying to give airline passengers in other nations the opportunity to make small, voluntary contributions when they purchase tickets.
In the meantime, we must do more with less. That means saving money on commodities and promoting better co-ordination of funding between donors and national governments. It means ensuring that low-cost/high-impact interventions are widely adopted, and asking donor nations to improve their own delivery systems so that a higher percentage of aid funds are spent in the beneficiary nations and on the problems they are intended to alleviate.
My foundation has focused on lowering the cost of commodities since we began our work in 2002. Thanks to those efforts – along with the support of organisations like UNITAID, the Global Fund, PEPFAR, and the Gates Foundation – the cost of antiretroviral drug treatment (ARVs) has gone down to below $200 per person annually. The cost of CD4 tests, which allow doctors to assess how patients are responding to treatment, and other laboratory tests, has also dropped by over 50 per cent.
But we need to break down remaining barriers – including trade agreements that prevent generic manufacturers from supplying effective ARVs for the developing world, and we need to do a better job on forecasting demand, to avoid overstocking, drug shortages, and expired inventory.
We must co-ordinate funding flows better between donors and national governments to ensure that resources are aligned with the most pressing national priorities. We must also reduce duplication and under-investment.
For example, the government of Rwanda has required that its implementing partners submit budget and expenditure data. From these reports, the government learned that some areas were receiving $15 per capita of external aid per year, whereas others only received $4. The Rwandan ministry of health used this data to form agreements with partners to ensure a more equitable and efficient allocation of resources. Other governments should follow Rwanda's lead.
We can maximise our return on investment by ensuring that low-cost/ high-impact interventions are adopted on a wider scale. For example, providing all HIV-positive people in sub-Saharan Africa with the antibiotic Co-trimoxazole – from the time that they are diagnosed – would dramatically lower mortality from common conditions such as pneumonia and diarrhoea at a cost of just $0.37 per patient, per year.
This should be a basic standard of care. Another important intervention is the prevention of TB, which directly causes one in four deaths among HIV-positive patients. Treatments like Isoniazid prophylaxis can reduce TB infection amongst HIV patients by up to 64 per cent.
Finally, all of us should continue to urge donor nations, as Bill Gates and I did before the US Senate Foreign Relations Committee, to review their own budgets with a view to reducing overheads. If the cost of consultants from donor nations were cut, more aid could be spent on saving lives.
These are just a few ways in which we can maximise the impact of our efforts in a period where funding isn't keeping up with the increasing needs. We have to keep finding ways to do things better, faster, and at lower cost. For example, at our 2006 Clinton Global Initiative Meeting, Levi Strauss & Co committed to provide all of its employees and their families with access to HIV/Aids treatment, counselling, preventive care and education in more than 40 countries where the company operates.
To date, the programme has enrolled more than 3,000 employees and managers. In 2010, their second voluntary counselling and testing campaign in South Africa has tested more than 75 per cent of their employees – one of the highest participation rates nationwide.
This World Aids Day, in spite of the economic crisis and the increased competition for aid funds, we can continue saving more lives by giving more people a chance to help and doing more with the funds we already have.
The writer was the 42nd President of the United States, and is founder of the William J. Clinton Foundation