(12) The Office of the Global AIDS Coordinator reports that at the end of March 2005, the PEPFARGlobal HIV/AIDS Initiative was supporting antiretroviral therapy for more than 235,000 AIDSpatients in the focus countries. (16) Some patients receivingtreatment for AIDS are participating in programs supported by both PEPFAR and the Global Fund. (17) 

	Global Fund Resource Gap

The Global Fund estimates that it needs $3.3 billion in 2006 and 2007 to cover all existinggrants through the end of 2007. In addition, it is seeking $3.7 billion, for a total of $7 billion, inorder to respond to anticipated applications in Rounds 6 through 8 during the two-year period. (18) At a pledging conferenceheld in London in September 2005, donors pledged a total of $3.7 billion. Unless additional pledgesare made, the Global Fund will have the resources to do little more than fund its existing grants. Itwill not be able to bring new resources to bear in fighting the AIDS pandemic. For FY2003 through FY2005, theAdministration requested $200 million annually, but Congress provided more than requested in eachyear. Funding for U.S. Global Fund and PEPFAR in U.S. Policy

Representatives of the Global Fund and PEPFAR consistently maintain that the two arepartners rather than competitors in the struggle against AIDS. (23) AnAugust 2005 Global Fund press release affirmed that the two programs are partners, noting that"Together, the Global Fund and PEPFAR are the major financial engines to achieve greatly increasedtreatment numbers over the coming years." (24) Jack Valenti, President of Friends of the Global Fight AgainstAIDS, Tuberculosis, and Malaria, which advocates for the Global Fund in the United States,describes the Fund as the "multi-lateral arm of PEPFAR, complementing the work of U.S. bilateralprograms around the world." Bycontributing to the Global Fund, the United States is able to "leverage" its investment for fightingthe pandemic because the Fund provides a means for other donors, most of which lack the capacityfor carrying out large bilateral AIDS program, to participate in fighting the pandemic. (28) The tendency of the Administration to request less for the GlobalFund than Congress was willing to provide may be traced to these anti-multilateral points of view,some believe. (29) However,even many of those who have been skeptical of the degree of partnership between the Global Fundand PEPFAR now acknowledge that there seems to be a new spirit of cooperation, as symbolizedin the Administration's $300 million request for the Fund in FY2006. Thus, the United States would have to contribute $2.3 billion in FY2006 andFY2007 combined, rather than the $600 million pledged by Ambassador Tobias, if it is to persuadeother donors to make contributions sufficient to meet the Global Fund's stated need of $7 billion. Administration officials and others argue that the United States has already been generous towardthe Global Fund, and should not be expected to do more. Table 2 suggests that the one-third rule may not be governing pledges by other donorsfor 2006 and 2007, although it is also possible that their pledges reflect an expectation that Congresswill add to the U.S. contribution. The United States has already contributed substantial amountsto the Global Fund, and some believe that a failure by the Fund to mobilize the resources it needsto fight the AIDS pandemic will to some degree be a failure of U.S. policy. Another option would be a concerted U.S. effort to persuade other donor countries to increasetheir contributions to the Global Fund even in the absence of a large U.S. increase. To date, however, non-government sources -- apart from theBill and Melinda Gates Foundation -- have contributed only modest amounts to the Global Fund.
The United States is responding to the international AIDS pandemic through the President'sEmergency Plan for AIDS Relief (PEPFAR), which includes bilateral programs and contributionsto the multilateral Global Fund for AIDS, Tuberculosis, and Malaria. PEPFAR overall appears ontarget to meet the Administration's five-year, $15 billion spending plan, although competing budgetpriorities could affect its prospects. By contrast, the Global Fund, which relies on multiple donors, is reporting a funding gap that may prevent it from awarding new grants to fight the pandemic. The Fund estimates that it needs $3.3 billion in 2006 and 2007 to cover the renewal of its existing grants,in addition to $3.7 billion in order to fund two new Rounds of grant-making. At a September 2005Global Fund pledging conference in London, donors offered a total of $3.7 billion for the two years,and unless additional pledges are made, the Fund will be able to do little more than fund existinggrants.
The United States, at the London meeting, pledged a total $600 million for 2006 and 2007,although Andrew Tobias, the U.S. Global AIDS Coordinator, suggested that Congress might providea larger amount. Congress has consistently appropriated more than requested for the Fund. Somebelieve that the Administration increased its FY2006 request for the Fund to $300 million, from$200 million sought in FY2003-FY2005, in recognition of the support the Fund enjoys in Congress.
Representatives of the Global Fund and PEPFAR maintain that their programs arecomplementary, and that they are partners rather than competitors. The United States is the largestcontributor to the Global Fund through PEPFAR. Some worry, however, that there are strainsbetween U.S. officials and the Global Fund, pointing to the tendency of the Administration torequest less for the Fund than Congress has been willing to provide. Global Fund representativesattended a major PEPFAR planning session in May 2005, and this is seen by many as one indicatoramong others that any past strains between the two programs are easing.
Advocates for the Global Fund seek a major increase in the U.S. contribution, arguing thatit would affirm U.S. leadership in the struggle against AIDS and persuade other donors to increasetheir support. They believe that the Global Fund has several unique advantages, including itsmultilateral character, its contribution to capacity building, and its operations in countries other thanthe 15 PEPFAR focus countries. Supporters of U.S. bilateral programs note that they too buildcapacity and operate beyond the focus countries, while bringing the capacities of highly experiencedU.S. agencies to bear in fighting the pandemic. Through PEPFAR, some argue, the United Statesis already doing more than its fair share in fighting AIDS, and any large increase for the Global Fundshould come from other donor countries. U.S. officials and others are also encouragingcontributions from private sector sources. Such contributions have been limited to date, apart from$150 million contributed by the Bill and Melinda Gates Foundation. This report will not be updated. For further information, see CRS Report RS21181, HIV/AIDS International Programs:Appropriations FY2003-FY2006 and CRS Report RL31712 , The Global Fund to Fight AIDS,Tuberculosis, and Malaria: Background and Current Issues .