The problem with a nonprofit response to AIDS in Africa

I have been studying the role of nonprofit organizations in the international HIV/AIDS crisis for about 10 years. During that time, I have had waves of both encouragement and doubt. Encouragement, because HIV/AIDS NGOs are among the most cooperative and during the 2000s the funding for AIDS was increasing year over year. However, doubts arose about a largely non-profit centered solution with largely Western dollars. I wondered how long this system could continue. Long-term, non-wavering problems are not suited for voluntary, charity-based solutions.  According to Donald McNeil of NYT, my doubts may be well founded. The donor dependence problems that vexed work in the infrastructure development space has extended to AIDS. Donors have tired of funding the same problem with no solution (there is no cure for AIDS, just nonstop treatment) or have come up short in their budgets due to "the current economy." Donor-drift is a particular problem with current AIDS medications, since one cannot stop taking them. To go off these medications, in addition to return of the progress of the disease, creates the opportunity for virus to mutate and become resistant to the current drugs.

This leads me to the sector blender topic: can a nonprofit, western donor-driven system be the sustainable source of healthcare for AIDS? If not, is there a mixed model that should be applied here (for example, pharmaceutical companies offering an affordable drug that either local governments or patients could afford and a group like Riders for Health could deliver)? And if we enacted changes to improve the condition of Africa's poorest countries, would government be able to partner more effectively with businesses, nonprofits, and UN organizations?

I don't have a great answers, but I do have the words from Nelson Mandela's 2005 speech at the Live 8 concert that still ring true (or perhaps more so) in the face of donor-drift.

"We live in a world where the Aids pandemic threatens the very fabric of our lives. Yet we spend more money on weapons than on ensuring treatment and support for the millions infected by HIV.

It is a world of great promise and hope. It is also a world of despair, disease and hunger.

Overcoming poverty is not a gesture of charity. It is an act of justice. It is the protection of a fundamental human right, the right to dignity and a decent life.

While poverty persists, there is no true freedom. The steps that are needed from the developed nations are clear.

The first is ensuring trade justice. I have said before that trade justice is a truly meaningful way for the developed countries to show commitment to bringing about an end to global poverty. The second is an end to the debt crisis for the poor countries.The third is to deliver much more aid and make sure it is of the highest quality."