In 2005, world leaders at the G8 summit in Scotland pledged support for universal AIDS treatment coverage by 2010, a promise that encouraged many African governments to launch ambitious treatment programs and that helped to expand coverage to more than 4 million people in developing countries. And now those same leaders are retreating from the pledges made, leaving governments and millions of people with HIV/AIDS at a dangerous loss.
The crisis is far from over. An estimated ten million people living with HIV/AIDS in the developing world are in urgent clinical need of antiretroviral (ARV) therapy. HIV/AIDS is the leading cause of death among women of child-bearing age worldwide and accounts for more than 40 percent of deaths of children under the age of five in the six highest HIV prevalence countries, according to the World Health Organization (WHO). Eighty percent of all deaths in Botswana and two-thirds of all deaths in Lesotho, Swaziland, and Zimbabwe are due to AIDS.
The US President's Emergency Plan for Aids Relief (PEPFAR), which has provided funding for treatment for 2 million people since its inception in 2003—and which has pledged to treat a total of 4 million by 2013—is capping funding for two more years. MSF and others are starting to see disturbing early signs of the international community's retreat from AIDS treatment scale-up. In some African countries disproportionately affected by the HIV/AIDS pandemic, people seeking treatment are being turned away from clinics. Patients already receiving ARV therapy are being forced to interrupt their treatment because they can no longer afford it, thus increasing their chances of becoming sick and developing resistance to drugs. In Free State Province, South Africa, alone, an estimated 3,000 people with HIV/AIDS died when funding problems led to a moratorium on treatment.
The lack of funding increases to provide treatment for the millions of people living with HIV/AIDS come at a time when MSF medical teams—providing ARV therapy to 140,000 patients in 30 countries—are witnessing an urgent need for an increase in funding—to scale up access to treatment, to provide patients with the more robust and better-tolerated treatments that are widely available in wealthy countries, and to provide better adapted pediatric formulations.
In one of the longest running public sector AIDS treatment programs in Africa, a partnership between MSF and the Department of Health in Khayelitsha, South Africa, 16 percent of patients experienced treatment failure on their first-line regimen within five years. A quarter of those patients who were switched to a second-line regimen failed on this alternative treatment line within two years. With no third-line regimen available in South Africa—as is the case in many other developing countries—these patients are now at risk of dying.
Furthermore, WHO’s new guidelines for preventing and treating the disease recognize, among other recommendations, the health benefits of starting people living with HIV on ARV treatment sooner. With few signs of the international commitment to make these new guidelines a reality, there is little hope that what has become a chronic disease in developed countries will stop anytime soon from amounting to a death sentence for the majority of those living with HIV/AIDS in the poorest of countries.
MSF is calling for governments to fulfill their commitments to provide access to life-saving AIDS treatment for every person in need and to fully fund the fight against AIDS, including through the Global Fund to Fight AIDS, TB, and Malaria. Additional funds are needed to address a number of health priorities. Innovative new funding mechanisms, such as a tax on currency transactions, could be used to protect public health around the world.