	Background

The Global Fund to Fight AIDS, Tuberculosis, and Malaria (Global Fund, or the Fund) was established in January 2002 as a public-private partnership to provide significant financial support for global responses to HIV/AIDS, tuberculosis (TB), and malaria. By the end of 2011, the Global Fund had approved roughly $22.6 billion to help 150 countries fight HIV/AIDS, TB, and malaria. Grants supported by the Global Fund have reportedly provided 
AIDS treatment for 3.3 million HIV-positive people, anti-tuberculosis treatment for 8.6 million people, and 230 million insecticide-treated nets for the prevention of malaria. The Global Fund expects to offer new funding for grants in 2014. 4. U.S. Support of the Global Fund

Since the Global Fund was established, the United States has been a strong supporter of the organization. Global AIDS Coordinator, Ambassador Eric Goosby, linked the success of U.S. bilateral HIV/AIDS programs under the President's Emergency Plan for AIDS Relief (PEPFAR) to the continuance of the Global Fund:
Our dependency on the Global Fund is a real one.... On October 4, 2010, when Global Fund donors met to make 2011-2013 pledges, the United States made its first multiyear pledge to the Fund of $4 billion. In FY2011 and FY2012, appropriations for the Fund remained at $1.05 billion. In order to meet his multiyear pledge to the Fund, made in 2010, as part of the FY2013 budget request, President Obama requests that the Fund receive an addition $250 million in FY2012 through a transfer of funds from the State Department's bilateral HIV/AIDS funding from that year. At the Global Fund Board's 23 rd meeting, held in May 2011, the board approved a series of measures recommended by the reform working group, including 
strengthening the accountability framework —enhancing fiduciary control and risk management, improving the tailoring of risk management approaches to local contexts, and applying stronger standards for implementers; strengthening partnerships —at the country level, introducing formal agreements on technical and management assistance and at the global level, better clarifying partnership roles; enhancing value for money —leveraging the Global Fund's market-shaping role to improve price, quality, and availability of key health products, and encourage reprogramming of funding toward more cost-effective interventions; improving governance —reviewing the Global Fund Board's governance structures and operating procedures to ensure more efficient and effective decision making; and adapting the Global Fund business model —moving from one-size-fits-all solutions to better take into account the grant performance record, implementation risks, and the extent of Global Fund support in countries relative to other health financing. Shortly thereafter, both critics and supporters of the Global Fund released statements about corruption in foreign aid in general and the Global Fund's response to corruption in particular. Issues for Congress

Since making a founding pledge to the Fund in 2001, the United States has strongly supported the Fund: U.S. contributions have remained higher than any other country, U.S. officials have served on various Global Fund boards, and Congress has steadily raised appropriations to the Fund. Although some Members of Congress argue that cuts to these programs could yield important savings, others contend that the cuts would have little impact on the federal deficit, while significantly imperiling the lives of vulnerable populations reliant on U.S. assistance. The section below discusses issues the 112 th Congress might consider as it debates spending levels for the Global Fund. FY2013 Budget Debate

The FY2013 budget request included $1.65 billion for the Global Fund, a significant increase from previous years in contrast to some proposed cuts in bilateral global health programs. Should Congress meet the President's request, the Fund will become an even greater share of U.S. global HIV/AIDS, TB, and malaria spending in FY2013. Some also argue that the fund allows donors to pool and leverage their resources, reduces overlaps in programming, and has fewer overhead costs. In November 2011, the Global Fund announced that, due to inadequate resources from donors, it would cancel its 11 th round of funding and would not be supporting any new grants until 2014. These included calls to: 
1. 3. 7. Despite these achievements, observers raise several issues that could influence U.S. support for the Fund:
The appropriate balance between U.S. support for the Global Fund and bilateral HIV/AIDS, TB, and malaria programs —Since the Global Fund was created, some have weighed U.S. contributions to the Global Fund against U.S. spending on bilateral HIV/AIDS, TB, and malaria efforts. The Fund's responses to allegations of corruption —The Global Fund's announcement that funds from some its grants were misspent has opened a rigorous debate in the foreign aid community. On the other hand, some have called for governments to withhold support for the Global Fund until adequate safeguards are established.
The Global Fund to Fight AIDS, Tuberculosis, and Malaria (Global Fund, or the Fund) was established in 2002 as a public-private partnership that could provide significant financial support for global responses to HIV/AIDS, tuberculosis (TB), and malaria. By the end of 2011, the Global Fund had approved roughly $22.6 billion to help 150 countries fight these three diseases. According to the Global Fund, from 2002 through 2011, it had supported AIDS treatment for 3.3 million HIV-positive people, anti-tuberculosis treatment for 8.6 million people, and 230 million insecticide-treated nets for the prevention of malaria, saving about 7.7 million lives.
In November 2011, the Global Fund Board announced that due to inadequate resources from donors, it would cancel its 11th round of funding, but would maintain support for existing activities to avoid disruptions in ongoing services. The Fund also announced that it expected to offer new funding for grants in 2014.
The United States has demonstrated strong support for the Global Fund since making a founding pledge in 2001. U.S. officials have served on several Global Fund boards, U.S. contributions to the Fund have surpassed those of any other country, and U.S. global HIV/AIDS, TB, and malaria programs have been increasingly coordinated with Global Fund activities. Donors last met on October 4, 2010, to make their pledges for the Global Fund over the next three years. There, the United States made its first multiyear pledge to the Fund of $4 billion.
Despite rigorous debate on the overall budget and the role of foreign aid in particular, the 112th Congress has maintained support for the Global Fund. In both FY2011 and FY2012, Congress appropriated $1.05 billion for the Global Fund, excluding rescissions. In order to meet the $4 billion multiyear pledge made in 2010, the President's FY2013 budget request included $1.65 billion for the Global Fund, a significant increase from previous years. As part of the budget request, the Administration requested a transfer of $250 million from the State Department's FY2012 bilateral HIV/AIDS funding to the Global Fund, bringing the estimated FY2012 funding level to $1.3 billion.
Global health advocates urge Congress to meet the President's FY2013 request for the Fund in order to support the sustainability of its activities and to encourage continued contributions from other donors. Although Congress has traditionally been a strong supporter of the Fund, several issues may affect congressional views about the Fund in the future. Such factors include the following:
Fiscal austerity. Proposals to reduce federal spending continue to dominate foreign aid debates, with some Members of Congress aiming to target foreign aid accounts, including those for global health, in an attempt to balance the budget. At the same time, others argue that cutting back on the relatively small size of foreign aid (about 1% of total budget authority) will do little to cut the deficit, but could imperil the lives of millions.
Oversight and transparency. In early 2011, reports about misuse of Global Fund resources in some grants ignited a debate about corruption in foreign aid in general, and in the Global Fund in particular. Some have called for donors to withhold support for the Fund until better safeguards are established. Others argue the Fund should not be penalized for oversight shortcomings, which are familiar to many aid programs.
Role of the Global Fund in U.S. global health policy. When the Global Fund was established, U.S. bilateral investments in HIV/AIDS, malaria, and TB were relatively small. Since then, U.S. bilateral investments in fighting these diseases have grown significantly, particularly since the President's Emergency Plan for AIDS Relief (PEPFAR) and the President's Malaria Initiative (PMI) were launched in 2003 and 2005, respectively. Some observers advocate allocating the majority of U.S. funds for global HIV/AIDS and malaria to bilateral programs to ensure sufficient control and oversight of funds. On the other hand, other analysts argue that the Global Fund represents a more efficient and flexible funding mechanism than bilateral programs and offers the United States the ability to pool funds and share risk with other donors, which some believe is particularly important given the challenges of the current fiscal environment.
This report provides background information on the Global Fund, outlines U.S. funding for the Fund, discusses changes the Global Fund has made to improve the efficiency of its programs and address allegations of corruption, and analyzes issues Congress might consider as it debates the appropriate level of U.S support to provide the Fund.