Watchdogging AIDS funding has always been vitally important work since the priorities of people with HIV have often been ignored by governments. These efforts are even more vital in light of flatlining and in some cases declining donor resources for the HIV response globally. Evidence has shown that programs and policies deliver the highest-impact results when they are shaped by the people most affected by them. Health GAP brings that fundamental truth to bear in our work to make sure that the funding mobilized for the global HIV response is put to the best possible use and is subjected to pressure and scrutiny of people living with HIV.
Health GAP works with people living with and affected by HIV, criminalized and marginalized communities, and other activists and civil society groups – from Washington D.C. and Geneva to Kenya and South Africa – to shape how HIV funding is used around the world. Our goal is to ensure that every dollar is used for high-impact, evidence-based programs that prioritize the real needs and demands of people living with and affected by HIV.
Bilateral and multilateral donors finance almost 50% of the global HIV response in low- and middle-income countries. In particular, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund), account for the lion’s share of these funds, giving these initiatives and, the U.S. government in particular, significant influence on priorities and programs in many of the most-affected countries. Since the creation of these initiatives, Health GAP has led efforts to ensure people living with and affected by HIV, and their allies, are at the table when powerful donors like PEPFAR and the Global Fund are making important decisions that will impact their lives. Today, Health GAP works with organizations of people living with HIV, LGBTQ groups, and other civil society organizations to watchdog major donors – PEPFAR Watch (see below) is currently active in more than a dozen countries. Our goal: to make sure that funding for the AIDS response is used for maximum effect – to support the achievement of ambitious targets and evidence-based strategies that reflect the priorities of people in urgent need of life-saving services. We then complement these efforts by reinforcing demands made by civil society in each of these countries in the halls of donor institutions in Geneva and Washington, D.C.
Governments should be responsible for ensuring a strong national HIV response and providing life-saving medicines and services for their people. Far too often, however, decision-makers and public institutions fail to live up to these obligations. In many countries, efforts to end the AIDS epidemic are impeded by massive underfunding of HIV in particular and health service delivery overall, chronic mismanagement and lack of political will among political leaders, corruption in the public health sector, decision-makers’ resistance to pursuing evidence-based strategies, as well as systemic criminalization of people with HIV and communities at greatest risk of infection, discrimination, misogyny, homophobia, and transphobia. Health GAP works with allies in countries heavily impacted by HIV to support national efforts to win expanded domestic investments, policies and laws that fight stigma and discrimination, an end to corruption in health service delivery, and to keep the pressure on governments to live up to their obligation to put the lives and health of their people first.
PEPFAR was created by then-President George W. Bush in 2003 after three years of activist pressure. It grew from a 5-year, $15 billion program to become the largest bilateral development assistance program for the HIV response. PEPFAR is critically important to the world’s efforts to end the AIDS pandemic.
However, in its first decade, PEPFAR refused to fund vital evidence-based programs for sex workers, men who have sex with men, and people who inject drugs, instead funding ineffective abstinence-only programs. PEPFAR’s resource allocation and other decision making was largely a black box to civil society and communities in recipient nations. As a result, tens of billions of dollars were invested without the benefit of watchdogging by the communities most in need of critical, evidence-based HIV treatment and prevention services.
Health GAP founded PEPFAR Watch, an international coalition of civil society groups and individual activists working to ensure transparent and accountable U.S. funding for the global HIV response.
Health GAP works with activists in PEPFAR countries to set priorities for and identify problems with the yearly Country Operational Plans (COPs) that guide each country’s use of PEPFAR funds. With our civil society partners, we’ve held trainings on how to use PEPFAR data for greater impact, created resources to help demystify PEPFAR’s planning process, provided strategic support to allies in key PEPFAR-recipient countries in data analysis and crafting advocacy strategies to influence this program, and fought side by side with allies to win major re-allocations in PEPFAR budgets to to try to ensure PEPFAR funds are put to the best possible use.
Through PEPFAR Watch, Health GAP is working to increase civil society’s impact at the decision-making table in order to shift large sums of money to better meet the needs of communities. High-impact international watchdogging is particularly important in this moment, as the effectiveness of U.S. bilateral support for the AIDS response under the Trump administration is under threat, including the reinstatement and expansion of the Global Gag Rule and abstinence-only programing creeping back into PEPFAR plans and guidance.