Funding retreat a threat to AIDS achievements - MSF

A retreat from international funding commitments for AIDS threatens to undermine the dramatic gains made in reducing AIDS-related illness and death in recent years, according to a new report by Médecins Sans Frontières (MSF).The MSF report highlights how expanding access to HIV treatment has not only saved the lives of people with AIDS but has been central to reducing overall mortality in a number of high HIV burden countries in southern Africa in recent years.

Over the past decade, enormous resources have been mobilised globally to address the HIV/AIDS crisis on a large scale. Médecins Sans Frontières (MSF) has seen first-hand the achievements, as well as some of the shortcomings, of these efforts in the course of providing care and treatment in more than 30 countries.

The good news is that four million HIV-positive people are alive on antiretroviral therapy (ART). The scale-up of ART in developing countries has allowed individuals to live longer and enjoy a better quality of life, leading to a restoration of dignity and autonomy, and an ability to contribute to family and societal life. In some countries, ART coverage has resulted in a decline in overall mortality and other population-level impacts. (See box on page 3)

But there is also bad news. Today, MSF teams working to treat HIV/AIDS are witnessing worrying signs of waning international support to combat HIV/AIDS. In some high-burden countries, patients are being turned away from clinics, and clinicians are once again being forced into the unacceptable position of rationing life-saving treatment. At the same time, more robust and better-tolerated treatments – widely prescribed in wealthy countries – are not reaching patients.

The most glaring sign of the decreasing political commitment to HIV/AIDS is a major funding deficit. The Global Fund to Fight AIDS, Tuberculosis and Malaria Board is considering a motion to cancel the funding round (Round 10) for 2010; if accepted, no new proposals will be considered until 2011.

Similarly, the US President’s Emergency Plan for AIDS Relief (PEPFAR) plans to “flat-fund” its programmes for the next two years, reneging on promises made last year to support expanded treatment access.

Meanwhile, a dangerous trend is underway in the global health policy arena. Rather than looking for ways to leverage and replicate the success of the AIDS public health revolution to improve global health, there are increasing calls for a diversion of foreign aid away from HIV/AIDS and towards other health priorities.

While there is clearly a need to give urgent and additional resources to an array of global health priorities, not least maternal and child health, cutting HIV/AIDS funding is not the answer.

Reducing funding at this juncture would not only undermine the goal of reducing maternal and child mortality, but it could also lead to the interruption of treatment for people with HIV/AIDS already on ART, and leave those still in need of access to treatment to die premature, avoidable deaths.

HIV/AIDS is the leading cause of mortality among women of child-bearing age worldwide and responsible for more than 50% of mortality in five of the countries with the highest HIV prevalence. This killer disease is an ongoing emergency that requires dedicated resources at the national and international levels. A strengthened commitment to other global health priorities must happen – but it must happen in addition to, not instead of, a continued and increasing commitment to HIV/AIDS.

Donors backtracking on funding AIDS treatment

Lives of AIDS patients in poor countries could be severely compromised if donors and rich nations continue reducing their funding commitments to AIDS programmes.

Independent humanitarian aid agency, Medicins Sans Frontieres (MSF), is urging major donors not to “wipe out gains” made by the roll out of anti-retrovirals (ARVs) by “retreating from their international funding commitments”.

In a report titled “Punishing success? Early Signs of a Retreat from Commitment to HIV/AIDS Care and Treatment”, which was published recently, the MSF singled out the US President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to fight AIDS, Tuberculosis and Malaria as having reduced their funding commitments to the response to AIDS. These are two major organisations supporting crucial AIDS treatment programmes in the developing world.

“We are told by the White House in the United States that the budget coming from the White House to Congress this month will have a flat funding of PEPFAR for 2011. This will have disastrous effects on the countries that are relying upon PEPFAR funds”, said Sharonann Lynch, MSF Policy Advisor.

The MSF also raised concern over the “funding deficit of the Global Fund to fight AIDS, Tuberculosis and Malaria (Global Fund)”.

Lynch said “in 2008 alone, the Global Fund had to cut funds to already approved proposals by US$ 1, 5 billion (R11, 2 billion)”.

Some African countries are already feeling the effects of this “retreat” in funding commitments.

“In Uganda, currently, PEPFAR supported facilities have been told that they must suspend treatment for new patients in need. Some are doing what they can, at least, putting pregnant women on treatment or putting the very sick on treatment or people who have TB/HIV co-infection”, said Lynch.

“Others have been told that they can only put new people on treatment if someone dies that is currently on ARVs, thus freeing up the space or if someone has been lost to follow-up. None of that is good news”, she continued.

Dr Tido von Schoen-Angerer, Director for MSF Campaign to Essential Medicines, said backtracking on funding ARVs will result in the premature death of those in desperate need of the life-saving drugs.

“AIDS is a continuing emergency. In the 10 highest HIV prevalence countries, AIDS continues to be the leading cause of death. Eighty percent of the deaths in Botswana are due to AIDS. Two-thirds of all deaths in Lesotho, Swaziland (and) Zimbabwe are due to AIDS”, he said.

The dwindling financial support for ARV programs by western donors is an “international betrayal”, according to Dr Eric Goemaere MSF Medical Coordinator in South Africa and Lesotho.

“The message five years ago was very clear: ‘Be ambitious, scale up, recommit to universal access by 2010! Go for it and we will support you’! Today, there is a message saying, ‘well, we are not sure that we can support you’”, said Dr Goemaere.

“This reminds me of some sort of ‘medical apartheid’ that definitely none of us in the MSF wants to live through”, he added.

Dr Goemaere further cautioned against “undermining the dramatic gains made” in encouraging people to know their HIV status.

“Ten years ago in Khayelitsha, Cape Town, we tested 1 000 people per year. Today, we test close to 40 000 people per year”.

“What does it mean”, he asked?

“‘We trust that if we test positive you are going to provide us with treatment’. That’s what it means”, he gave the answer.

“If there’s no treatment, nobody goes for a test”, he concluded.