$12 Billion Is Pledged to Fight AIDS, TB and Malaria

The world's donor countries on Tuesday pledged $12 billion over three years to the Global Fund to Fight AIDS, Tuberculosis and Malaria.

The amount was more than the fund took in at its last pledge conference in 2010, but less than the $15 billion it had hoped for. And it is far short of the ambitious goal of $10 billion a year set when the fund was created in 2002.

Despite the Obama administration's insistence that "an AIDS-free generation is in sight" and Bill Gates's 2007 call to eradicate malaria, $4 billion a year for each of the three fronts on which the fund is fighting epidemics will not drastically alter any of them.

Dr. Mark R. Dybul, the fund's executive director, called the $12 billion "incredible" and said he hoped to pry more soon from several countries and wealthy individuals. "Whether we'll get to the $15 billion, I don't know," he said.

Reactions among advocates for the poor were divided: Some were grateful that donations had gone up, others bitter that rich countries continued to do much less than is needed for victory.

Chris Collins, director of public policy at amfAR, an anti-AIDS group, called the $3 billion gap "disappointing" but said that even $12 billion "showed that there is growing optimism that the fund is an effective tool."

But Matthew Kavanagh, Mr. Collins's counterpart at the Health Global Access Project, said it was "inexcusable that we are not yet on track to halt the AIDS crisis because of lack of funding." And a spokeswoman for the medical charity Doctors Without Borders said the fights against AIDS, tuberculosis and malaria "took a big hit today."

Although $12 billion appears comparable to the amount raised at the 2010 conference, the fund said it was actually 30 percent more. Seth Faison, a spokesman for Dr. Dybul, said the 2010 announcement of $11.7 billion included $2.5 billion in projected pledges, which he characterized as "guesses." Only $9.2 billion was firm, he said, and over the ensuing three years, some countries reneged and some unexpected donations arrived.

The final amount received was $10.4 billion, Mr. Faison said. (The 2010 conference, held during the global recession, was a disappointment: Dr. Michel D. Kazatchkine, Dr. Dybul's predecessor, asked for $20 billion and said $13 billion was the minimum needed to keep the fund going. Two years later, the fund had a cash-flow crisis so acute that the Bill and Melinda Gates Foundation stepped in with $750 million.)

Still, the need remains far greater. In April, the fund estimated that $15 billion would help 85 percent of the people in need; by that measure, $12 billion would help 68 percent.

To combat AIDS alone, the United Nations has estimated a total need of $24 billion to $27 billion a year. Current spending is $19 billion, half of it from donors.

About 10 million people infected with H.I.V. receive antiretroviral drugs. But a total of about 35 million are infected, and that number grows by 2.3 million a year.

AIDS experts now advocate a "test and treat" policy, recommending that anyone who tests positive take drugs, which greatly reduce the risk that they will infect others.

That goal is clearly unreachable, said Mr. Kavanagh, of the Health Global Access Project.

Malaria deaths have dropped to about 650,000 a year from one million a few years ago, thanks to insecticide-impregnated nets, indoor spraying and new artemisinin-based drugs. But nets tear, insecticides fade and drugs run out, and malaria can rebound rapidly. Just keeping the death rate steady at 650,000 takes continuous investment.

Last year, the World Health Organization warned that the war on malaria was in danger of falling apart for lack of funds.

Tuberculosis is theoretically easier to tackle because first-line drugs are cheap, but the number of cases rises with H.I.V. infections because latent tuberculosis can be activated when the immune system is depressed.

As always, the United States was by far the largest donor to the fund.

President Obama had offered to pay a third of the fund's costs up to $5 billion over three years. But because the pledge was a one-for-two match and other countries pledged $8 billion instead of $10 billion, the United States' contribution will now be only $4 billion.

Since the first funding round in 2004, the United States has repeatedly offered more than others could match.

This week, Britain gave $1.6 billion, nearly triple its previous pledge, and France gave $1.5 billion. Japan gave $800 million, 33 percent more than its previous pledge. Sweden gave 30 percent more, and Norway 25 percent more.

Mr. Gates added $200 million to a previous pledge, and Dato Sri Tahir, an Indonesian billionaire, gave $65 million for Indonesia.

Responding to calls for countries with any income to rely less on global donors, Nigeria contributed $30 million, and its finance minister said the country would shift $50 million a year out of fuel subsidies and into fighting AIDS. Nigeria has the world's second-largest AIDS epidemic, after South Africa.

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