Andrew Leigh

I'm in Sao Paulo this week, attending the Partnership Forum for the Global Fund to Fight AIDS, Tuberculosis and Malaria, which is a strategy conference held every 2-3 years.

The conference is mostly implementers and NGOs, with a smattering of politicians (I've enjoyed chatting with Mark Lancaster, a moderate Tory who is the principal private secretary on international development to the Secretary of State).

Six things I've learned since I arrived:

1. There are forms of malaria that can kill you within 24 hours of the first symptoms.


2. After mosquitoes bite an infected person, they need to sit in a dark corner. So spraying insecticide in dark corners is surprisingly effective.


3. There's been a lot of emphasis on preventing mother-child transmission of HIV by ensuring all HIV+ mothers are on antiretrovirals during pregnancy. But after the birth, there often isn't the money to keep up treatment. The result is that we prevent the child being born with HIV (which is terrific), but pretty much guarantee that s/he will be an orphan within a few years. Hard ethical issues.


4. Treating regular TB costs a few dollars. Treating multi-drug resistant TB costs around $10,000.


5. The tendency for mission creep is strong - not surprisingly, given the Global Fund has mobilised nearly $22 billion in the past decade. But it's important to keep remembering that the reason donors have been so generous is that they think they know pretty precisely what their cash is going towards. Broaden the remit, and the dollars may disappear.


6. There's a lot of talk about reactionary government attitudes hampering the outreach efforts of HIV programs to marginalised groups such as sexworkers, men who have sex with men, and injecting drug users. But the policymakers who hold those views either aren't attending, or are staying very quiet. Instead, the atmosphere is very inclusive. My favourite moment came during a Q&A session today, when the MC said 'Everyone who has asked a question so far has been male - can I hear from a woman now?'. A voice piped up at the back of the room 'I'm transgender - does that count?'.