Global progress on HIV/AIDS is real: 5.2 million people are receiving antiretroviral therapy in middle-income and resource-poor countries, which is remarkable if you look at where we were five or ten years ago. The United States’ government’s push to ramp-up treatment, started under the Bush Administration, has continued under the Obama Administration. In early 2009, the President’s Emergency Plan for AIDS Relief (PEPFAR) provided treatment to 1.8 million people; today it treats 2.5 million people. Here at AIDS 2010, PEPFAR Ambassador Eric Goosby stated that PEPFAR is well on its way towards reaching the goal of offering treatment to 4 million people by 2013. This is heartening news.

Today’s funding constraints are also real, however, and the anger is palpable. Many people now see the possibility of achievinguniversal access by 2015 as a pipe dream. Too many donor governments have withdrawn or capped their financing of the Global Fund, which is one the largest international financing mechanisms for HIV/AIDS work. The Global Fund is only at 60% of the funding it needs for the 2010-2013 cycle, which begins in less than three months. Budget shortfalls are limiting the reach of life-saving HIV/AIDS programs. Here at AIDS 2010 in Vienna, vocal activists are protesting budget cuts with signs that say, “Broken Promises Kill, No Retreat, Fund HIV/AIDS,” and have directed their frustrations, in part, at the US government’s failure to keep its promise to fund PEPFAR II and the Global Fund at 100%. The signs reflect what many of us feel: a sense of loss amidst progress, grief for the thousands of people living with HIV whose access to treatment is drying up, and anxiety about whether people will be willing to seek HIV counseling and testing if they know they can’t get treatment.

But we must continue to forcefully advocate for global health funding, including ongoing support for HIV/AIDS programs.  On Monday, former U.S. President Bill Clinton, founder of the Clinton Health Access Initiative, spoke about how we need to supplement cuts in government funding by developing innovative strategies to partner with the private sector and encourage individual giving.  The 10 very logical strategies Clinton mentioned will help maintain our momentum in the fight against HIV and AIDS:

1. Replenish the Global Fund in October 2010 for the next three years, through 2013.
2. Make smart funding choices that benefit the larger global health agenda, meaning address HIV/AIDS through integrated programs with reproductive health and maternal, newborn, and child health work.  
3. Focus on strengthening health systems and the health workforce and encourage and support health workers beyond just doctors and nurses.
4. Scale-up evidence-based practices that work.
5. Examine our own organizations and how to reduce drug and service delivery costs.
6. Promote NGOs that can do high-quality work faster and at lower cost by offering them more donor support.
7. Reform funding and spending mechanisms for governments and local organizations by reducing overhead costs.
8. Challenge national leaders to devote more of their budgets to health care, particularly in mineral-rich countries.
9. Encourage and advocate for more private investments and individual giving and explain why this is good economics. Push donor governments, including those in emerging markets, to take responsibility for supporting global health work.
10.  Do more: HIV prevention needs more focus and tailored approaches within communities.

Over the past few days, we have heard again and again that treatment is prevention—you simply cannot separate the two.  Women and girls need more focus for comprehensive family-centered care if we are going to truly have any hope at all for universal access, particularly young women ages 15-19 who are contracting HIV at a rapid and frightening pace. Today, there are 7,400 people infected daily by HIV. This is only down from 8,800 daily in 2001. We need to continue to support prevention, through expanded testing and counseling and ensured access to treatment.

Governments, donors, and country and civil society leaders expect changes in how programs are funded and rolled out. There will be changes ahead. We all need to examine how we do business and how we can adjust to the financial realities by doing things smarter and more cost-effectively—and how we can be advocates of human rights and save more lives. We must all light our HIV/AIDS and global health activist flames—right now and right here.