Two new reports by UNAIDS provide a detailed current description of global AIDS coordination and finance issues. The first, "Global Task Team on Improving AIDS Coordination Among Multilateral Institutions and International Donors" (PDF / 717 kb) describes the necessary framework for effective coordination. The second, "Resource Needs for an Expanded Response to AIDS in Low and Middle Income Countries" (PDF / 573 kb), presents current estimates on available and required resources to combat global AIDS.

The two documents are interrelated -- it is necessary to have credible coordination before expecting increased AIDS funding. The two documents also pivot on one key point: current estimates show funding growing about 10% per year, while need is growing at about 20% per year. UNAIDS estimates a funding gap 2006 - 2008 of $22 billion.

Kudos to HBO Films for making an important (and entertaining) romantic comedy about -- the Millennium Development Goals (yes, that's correct). Screenwriter Richard Curtis (Four Weddings and a Funeral, Love Actually, Notting Hill) wanting to address a more weighty topic, penned a screenplay of serendipitous romance against the backdrop of a G8 conference debating poverty strategy. I saw last night the premier of "The Girl in the Cafe" at the French Embassy in Washington DC -- it is a fine film. The movie debuts Saturday June 25th at 8pm on HBO and will be replayed subsequently.

Is it time to change the name of PEPFAR? First, since PEPFAR isn't really the "President's" program -- but a program of the American people -- the first letter is confusing (note that the Global AIDS Coordinator's Office frequently refers to the program not only as the "President's Emergency Plan for AIDS Relief", but as "President Bush's Emergency Plan for AIDS Relief", such as three times in Monday's press release about treatment). Second, calling the effort an "emergency" program suggests a short time horizon which is the opposite of the desired impression.

Why not rename the effort APFAR -- "American Program for AIDS Relief"? I'm sure that http://www.apfar.gov is still available.

The Global Fund has announced it is directing a new advertising campaign in England, Italy and Germany in order to raise public awareness and support for global AIDS programs. While such a program is laudable, it seems questionable that the Global Fund itself would direct the effort (particularly since past advertising campaigns supported by the Global Fund have lingered, such as the "Investing in our Future" effort with VH1). The Global Fund, whose motto is "Raise it, Spend it, Prove it", has assiduously focused on core competencies in the past. It isn't obvious that ad campaigns represent a core competency.

Advertising and lobbying groups are experts in campaigns of this sort. Today's Washington Post story by Stephen Weissman describes a notional campaign for Darfur -- a model which lends itself comfortably to global AIDS as well.

In his June 2nd speech to the UN General Assembly high-level meeting, Peter Piot, Executive Director of UNAIDS, outlined "four milestones" necessary for the successful response to the AIDS crisis:

• Comparable attention to other threats to global security;
• Universal access to prevention and treatment services;
• Sufficient resources;
• Long-term planning horizon

Piot, to his credit, repeatedly returns to the theme of why AIDS is exceptional. Unfortunately, few political leaders adopt his language of urgency concerning AIDS. He notes in his closing remark:

My respectful call to you is that when this Assembly meets a year from now that it will not be to discuss what has not been done on AIDS, but to agree on action to address the material, and dare I say political, obstacles in the path to universal access to HIV prevention and treatment. We cannot afford to rest before this is achieved.

We've commended previously the IAS for the Future Directions Project, an online consultancy seeking global input into the design of the 2006 International AIDS Conference in Toronto. Since launch, the project has gathered about 75 public suggestions on conference design, most thoughtfully presented, representing voices from many countries. The IAS should distill good ideas from this feedback. What would be useful would be feedback from the IAS itself. The Project is currently unidirectional, with participants providing ideas. There is no public comment from the IAS, nor an idea of timelines, nor next steps. The "e-mail update" facility doesn't appear to have been used. A site blog with periodic updates could turn a public monologue into a true dialogue, make the exercise even more effective, and serve as an early model of the interactivity the IAS seeks to promote in its conferences.

Kudos to the New York Times for being a consistent voice in calling for increased US assistance for global AIDS and for African relief. Today's editorial "Crumbs for Africa" criticizes the Bush Administration for its miserly African aid offer of $674 million of funds already allocated by Congress.

The United States currently gives just 0.16 percent of its national income to help poor countries, despite signing a United Nations declaration three years ago in which rich countries agreed to increase their aid to 0.7 percent by 2015. Since then, Britain, France and Germany have all announced plans for how to get to 0.7 percent; America has not. The piddling amount Mr. Bush announced yesterday is not even 0.007 percent.

What is 0.7 percent of the American economy? About $80 billion. That is about the amount the Senate just approved for additional military spending, mostly in Iraq. It's not remotely close to the $140 billion corporate tax cut last year.

There is little enthusiasm in the Executive Branch for more generous assistance to Africa. Congress is somewhat better, but still ineffectual. Even the American public is divided: in today's CNN web poll "Is the United States doing enough to help Africa?", of the first 100,000 respondents, 51% answered "yes".

Most Americans believe we spend much more on assistance than we do. In reality we're at the bottom of the list of rich countries in terms of aid as a percent of GDP. As Jeff Sachs says, the notion that there is a flood of American aid going to Africa "is one of our great national myths." It unfortunately doesn't appear to be a myth that will be rectified soon.

In global AIDS programs, it is easier to measure inputs than results. Current calls for doubling of aid to Africa, and the US refusal to agree, represent the focus on inputs. India's recent vacillating numbers of AIDS cases represent the difficulty in measuring results.

There will soon be a major new initiative to try to shift the focus from inputs to results. The San Francisco Chronicle and the Harvard Crimson both report that Larry Ellison, founder and CEO of Oracle, will soon make a major gift to Harvard University to establish a research center for global health monitoring. The gift, reported to be approximately $115 million, would be the largest ever received by Harvard. According to Ellison:

"We measure philanthropy the wrong way. We measure the input -- how much someone gives. It's better to measure how many lives we save."

The research center reportedly will address needs articulated by Harvard Professor Christopher Murray, who wrote last fall in the British Medical Journal of the need for a global health monitoring organization independent of the WHO and government influences.

The objective of this body would be to report regularly to the world on what is spent on health, what health services are delivered, and the impact of these efforts on population health.

PEPFAR has concluded it's annual six-day conference, this year held in Addis Ababa. According to kaisernetwork.org, the conference emphasized a renewed commitment to prevention efforts in Africa, including door-to-door programs.

PEPFAR apparently has not put any information from the conference online as of yet (but may be forthcoming on the USAID Ethiopia site?) Some additional coverage is available via the Boston Globe.