Dr. Richard Feachem, executive director of the Geneva-based Global Fund to Fight AIDS, TB and Malaria, was in Seattle on June 24 to brainstorm at the Bill & Melinda Gates Foundation about what he regards as the world's "last best chance" to halt the AIDS pandemic. "This has got to work," Feachem said.

"There's not enough money to meet future projections," said Dr. Helene Gayle, Global Fund board member and director of the HIV/AIDS program at the Gates Foundation, which donated $100 million to the fund. The Bush administration has promised $1 billion to the fund, but Congress has not appropriated the money.

Of the fund's money troubles, Feachem said, "I think we're on an upswing now. We desperately need refinancing but I've received firm pledges of $4.6 billion. I think we're already beyond what most people would have realistically expected us to do."

"There is a strategy that we share with the Gates Foundation -- we demand performance-based funding. The fact that a country is suffering greatly, by itself, does not entitle it to funding. It's not a very popular thing to say but in practice it's not a big problem. Countries have an opportunity to apply again. We're investing in success," Feachem said. So far, he said, 65 percent of the approximately 160 grants to 85 countries have gone for HIV/AIDS, 17 percent for malaria and 14 percent for TB. Sixty-one percent of the grants have gone to sub-Saharan Africa.

Asked whether Americans understand the AIDS crisis in places like Africa, Feachem said, "A lot of people still don't get it. They don't understand how big the stakes are in all this. But I would say the awareness is sinking in and Americans seem to have a greater awareness than many others. Your secretary of state, Colin Powell, has repeatedly warned that AIDS is a greater threat to national security than terrorism. I think it's sinking in."

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