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The Global Fund to Fight AIDS, Tuberculosis and Malaria is the world's largest supporter of AIDS programs. It pays for more than half the world's HIV medicine. Last week, the fund made an ominous announcement: Due to the global financial crisis, it is well short of its fundraising goals. Now on World AIDS Day, many are worried about what that means for the future of the fight against AIDS. Anders Kelto is in Cape Town, South Africa, and files this report.

ANDERS KELTO, BYLINE: Inside the Ubuntu HIV clinic, dozens of people sit on wooden benches. They're here to collect their monthly supplies of anti-retroviral drugs - the medicine that allows HIV-positive people to stay healthy.

(SOUNDBITE OF PILLS IN BOTTLE)

KELTO: South Africa has more HIV-positive people than any country in the world. More than 6,000 people collect their medicine at this clinic in Khayelitsha, a sprawling township on the outskirts of Cape Town.

Nompumelelo Montangana is the operational manager. She says they've made huge strides in the fight against HIV. They've greatly increased the number of patients they treat, and have raised community awareness of the disease. But she says the Global Fund's financial shortfall has her worried.

NOMPUMELELO MONTANGANA: If the funding is not there, then that means what we have worked over the past 10 years, it just -it will be a waste.

KELTO: The Global Fund hopes to distribute $20 billion next year, primarily to programs in sub-Saharan Africa. Two-thirds of the world's HIV-positive people live there. But so far the fund has raised just half of that amount. Dr. Christoph Benn is the Global Fund's director of external relations.

CHRISTOPH BENN: So basically we are predicting the funding will remain at a similar level, hopefully with some increase, but it is currently not sufficient to call for a full new round of funding that would allow countries to scale up their current programs.

KELTO: That means people who now have access to anti-retroviral drugs won't be affected much. But roughly half the world's HIV-positive people live in areas with limited or no access to those drugs, and their situation probably won't improve.

Education and advocacy groups are also under threat. The Treatment Action Campaign, one of South Africa's most influential AIDS organizations, has said it will be forced to close its doors in January if Global Fund dollars aren't delivered as promised. And Dr. Eric Goemaere, the director of Doctors Without Borders for Southern Africa, warns that clinics in some countries could run out of anti-retroviral drugs.

DR. ERIC GOEMAERE: Worst case scenario is people who are already be on the treatment will have to be stopped. Countries like certainly Zimbabwe and Mozambique and probably Malawi will have extreme difficulties.

KELTO: The Global Fund receives 95 percent of its income from governments, primarily in Europe and North American. Now many of those governments are saying they can't pledge more money in the midst of the global financial crisis. But Dr. Goemaere says the problem is there's not the same political will around AIDS that there was a decade ago.

GOEMAERE: The real reason is that the political interest has definitely faded away, probably because it is not perceived as threatening as it was in that time for the rich countries, for European and North American countries.

KELTO: Despite the fears of AIDS advocates, the Global Fund says it can maintain support for current programs. South Africa, which has the largest economy in Africa, and a government that is committed to fighting the disease, is unlikely to see its HIV clinics close. But the same may not be true for many of its neighbors.

For NPR News, I'm Anders Kelto in Cape Town, South Africa.

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