A red ribbon is seen on the chest of a worker for an AIDS control and prevention NGO in Beijing. Photo: CFP

For grass-roots groups involved in HIV/AIDS prevention and advocacy, this year marks a turning point as many of them conclude the final phases of projects funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Since entering China in 2003, the Global Fund has contributed hundreds of millions of dollars to the country. Its decision to stop handing out new grants to China last year dealt a heavy blow to grass-roots groups who have been dependent upon such overseas grants. Some of them might even disappear as a result, while the rest try to figure out what to do next.

The Global Fund is a financing institution created in 2002 and brings together resources from the "government, civil society, civil society, the private sector and communities living with the diseases," to prevent, treat and care for people with those diseases.

Global Fund in China

The Global Fund has approved a total of over $800 million for China and disbursed over $775 million to date, according to its website. About 40 percent of the money went to HIV/AIDS programs. It has provided four rounds of funding as well as the RCC (rolling continuation channel) program.

In 2012, the Global Fund decided to cancel the next round of funding for China, as the country has become a middle- and upper-income country within the G20 group and the pandemic situation is no longer at a level of extreme severity. As a result, about $680 million of the approved budget of $1.814 billion for the 2010-15 period will not be allocated.

Most of the grants have been used for purchasing drugs and medication for patients. With HIV/AIDS grants, each round of program requires that a certain percentage of the money be used to support grass-roots groups. Round six of the Global Fund for HIV/AIDS programs, which started in 2007, focused heavily on strengthening the capabilities of grass-roots groups and NGOs to help the most vulnerable and inaccessible target populations.

In 2011, the Global Fund temporarily froze grants to China as it had not allocated 20 percent of the funding to grass-roots groups as previously agreed. Chinese authorities later responded that they had different definitions about what exactly constitutes a grass-roots organization.

Strictly speaking, grass-roots groups need to be registered at the civil affairs department with a government agency acting as a supervisor. But it has always been difficult for grass-roots groups and NGOs, devoted to any cause, to get registered.

The authorities' relationship with unregistered grass-roots groups has long been murky. By and large, the government has been cooperating with grass-roots groups to provide services and help to target those in need. But in other cases, authorities might use the fuzzy status of certain organizations against them, barring them from resources or cracking down on their activities.

Advantages on both sides

The money coming from overseas has magnified the problem to a certain extent. The Global Fund doesn't implement programs directly but relies on partners on the ground, while in China, the Center for Disease Control acts as its principal recipient. In China, however, the lack of transparency and performance-based evaluations has led to many problems, experts say.

Overnight, dozens of grass-roots AIDS groups appeared. Data compiled by grass-roots and official institutions shows the number of NGOs on HIV/AIDS grew less than 100 in 2005 to about 400 by 2007. Today it's estimated that there are over 1,000 NGOs working on HIV/AIDS issues.

Bickering has been constant in the past decade among grass-roots groups fighting over grants as well as between NGOs and program offices at different levels.

Not all of the organizations are truly motivated to help the cause. NGO leaders and experts in the field say they know as a matter of fact that some of these groups were just in it for the money. In some cases, local authorities help establish so-called grass-roots groups to get the grants. Those groups are born because of the money, and might disappear as the money goes away.

The government's mixed attitude towards grass-roots groups is at the core of the matter. "The government wants groups that they can control, but the really capable groups aren't always obedient, so either they become marginalized or repressed, or they succumb to pressure," said Jia Ping, founder and head of China Global Fund Watch Initiative, an independent watchdog over the activities of the Global Fund in China.

As a result what happens is that "bad money drives out the good." Good grass-roots organizations aren't always given the room to grow and resources become highly concentrated among a few government-backed groups. The authorities are still reluctant to be fully open towards grass-roots groups, and let them compete and grow on their own, which has to change in the future, said Jia.

Workers from the Yichang Center for Disease Control and Prevention in Hubei Province pass on knowledge about AIDS prevention and control to migrant workers on August 31. Photo: CFP

Despite the complaints, there's no denying the positive impact the Global Fund has had in China in the fight against HIV/AIDS, said Jia.

The Global Fund came into China at a time when HIV/AIDS was not yet a priority for the government and the public health system. Although the first AIDS case was found in China in 1985, China did not publicly acknowledge the severity of the outbreak until the turn of the century.

The issue was, and still is, sensitive at times. In the 1980s and 1990s, selling of blood plasma was encouraged in some parts of China as a way to reduce poverty. As a result, tens of thousands of people in central China became infected with HIV/AIDS. These people are still seeking compensation and justice today but their pleas have largely fallen on deaf ears.

In more recent years, sexual transmission has become the primary way for the disease to spread, while the authorities' attitude towards homosexuality has only gradually begun to evolve in recent years.

The money the Global Fund committed to China was timely and saved a lot of people's lives, NGO workers and observers say.

It also brought in new concepts such as anti-discrimination, gender sensitivity, and the equality of the marginalized populations, which were unheard of before, said Jia.

For grass-roots organizations, the most important thing the Global Fund brought to China was to bring them onto the stage and get them actively engaged in HIV/AIDS prevention.

Many NGO leaders started out as individual volunteers when their work among the community wasn't organized and they couldn't cover a lot of ground. They say that if it wasn't for the Global Fund, they wouldn't have received the training, known how to do community outreach or intervened with at-risk groups.

Zhu Jia, who founded the Jiudu work group in Luoyang, Henan Province in 2007, applied for the Global Fund program in 2008. It was the first time he had ever applied for any program. "Because of them, we learned how to do things, how to use the money," he said. His group received about 200,000 yuan ($32,700) from the Global Fund between 2008 and 2012.

Moving on

The loss of international funding may not wholly be a bad thing. A number of organizations whose only purpose was to take advantage of the money will disappear, and those really committed to helping the community will remain. And without having to fight over who gets what, more streamlined grass-roots organizations shall focus more on serving the community.

For some grass-roots organizations, the Global Fund accounts for most of their projects and without it, their work will surely be affected. Many people working for such organizations have expressed their anxiety over an uncertain future.

Last year, Chinese former premier Wen Jiabao said that the treasury would fill in the gap after the Global Fund leaves. On June 31, Premier Li Keqiang said the government would promote purchase of public services from NGOs.

The pledges have left people with a mixture of hope and concern. "Will the government keep its promise? How much money, and more importantly, how much of the money will actually go to the grass roots, or will it benefit those backed by the government?" said Xiong Weixiang, founder of the Lanyu group in Chongqing which focuses on intervention among the male gay population. "There are a lot of uncertainties and people are anxious." About 40 percent of the projects at his group are funded by the Global Fund.

Even though the government has indicated on many occasions the importance of outsourcing public services to NGOs, the specifics remain unclear. Many people are excited at the prospect but say they have no idea how such a process might work in practice.

Under the circumstances, some grass-roots organizations are considering repositioning themselves.

Zhu got involved in the field a decade ago when he and a couple of friends started an online chat group for gays. The idea was simply to engage more people and establish a sense of community among homosexuals. "Our vision was simple: to help gays live a happy life," said Zhu.

As infection rates of HIV/AIDS rose over the years, Zhu gradually realized the gay community was becoming increasingly vulnerable to the disease. In 2007, he founded the Jiudu work group to get involved in AIDS prevention work. The "mission" at the time he said, was to promote healthy habits, safety and the general happiness of the community.

But the Global Fund projects were output-oriented. They had to closely keep track of the number of people intervened or tested. "We became so focused on intervention work, which is important, but sometimes I feel it's not what we envisioned ourselves to be when we founded the group," said Zhu.

Zhu said he is considering getting back on track by promoting gay culture and gay rights in the future.

Faith remains

Many community group leaders got involved even before international funding started coming in. Almost all of them started out simply as volunteers who saw a problem and wanted to do something on their own to help.

Without the Global Fund or other support, many say they would just go back to where they started, volunteering with their own time and money. "Perhaps I could go start a business, and use my own money to do things to help the community," said Xiong. "Perhaps we don't have to cooperate with the government but do things our own way."

Whatever the format, many say they won't walk away from the struggle as the issue remains close to their hearts. Most of them are part of the gay community and some are HIV carriers or patients themselves.

Jia said that the government has made some good promises or pledges, but it's just a matter of taking the steps to change how the government views and manages grass-roots groups.

"If the authorities could approach the issue with a more open attitude and more transparency, if they could trust the community organizations and encourage benign competition, a lot of talented, capable people would step up and the grass-roots organizations would be able to provide quality services to target groups," he said.