Dramatic scaling up of targets to reduce the impact of HIV/AIDS, together with a tight deadline, requires unprecedented financial commitments from the international community. Spending on HIV/AIDS in developing countries has indeed increased exponentially, rising from $260 million in 1996 to over $10 billion in 2007, with funds sourced primarily from governments, international development agencies and philanthropists. The largest single source is the US government which appears likely to approve funding of $30 billion over 5 years from 2008 through renewal of the President's Emergency Plan for AIDS Relief (PEPFAR). About 25% of all global AIDS projects are granted by the Global Fund to Fight AIDS Tuberculosis and Malaria, established in 2002 to "attract and disburse additional funds".

Olayinka Jegede-Ekpe, Nigerian HIV activist © unknown / Prerana (Associate CEDPA)

UNAIDS says that annual spending needs to quadruple the 2007 figure to $42 billion by 2010. Considering that the entire 2006 foreign aid budget for sub-Saharan Africa was less than $40 billion, it is clear that the AIDS lobby aspires to a generous slice of the funding cake. Other human development sectors sometimes suggest that the AIDS priority has been overdone, comparing the 2 million annual deaths caused by AIDS with 10 million through hunger, 5 million due to unsafe water and 3 million stillborn babies. There have even been accusations that AIDS agencies inflate estimates of the number of people living with HIV/AIDS in order to attract funding. There are indeed significant difficulties in data collection; the most recent UNAIDS report absorbed new lower prevalence figures from India and other countries where statistical analysis has been improved and the agency has agreed to review its financial needs estimates.

The reason why HIV/AIDS has attracted generous funding is that 90% of its victims are carried off in the prime of life, ripping the heart out of a country's social and economic fabric. Life expectancy, one of the three core measures determining the UN Human Development Index, has fallen dramatically in many African countries; women in Zimbabwe and Zambia are more likely to die before rather than after their 40th birthday. The loss of teachers, health workers and even MPs in sub-Saharan Africa has disrupted the functioning of public life and undermined poverty reduction plans. Donor agencies have been responding to an emergency as much as development.

The less emotional analysis of commerce conveys an equal message of urgency. The World Bank has estimated that HIV/AIDS prevalence of 8% knocks 1% off a country's rate of economic growth. In Zambia business research has valued the loss of an experienced worker at $9,000 whilst an HIV prevention programme costs just $47 per employee. Major companies throughout southern Africa have invested in HIV/AIDS services for staff and local communities.

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