JOHANNESBURG/NEW YORK—The recent call by UNAIDS to “close the gap”around access to HIV services will not be met unless the delivery of antiretroviral treatment (ARV) is radically reshaped into community-led approaches that adapt to the realities of those living with HIV, said the international medical humanitarian organization Doctors Without Borders/Médecins sans Frontières (MSF) ahead of World Aids Day, December 1.
First-hand experience has shown that community approaches that make access to ARVs easier and less costly are key strategies which keep more people on effective HIV treatment, and slow transmission overall. These approaches are endorsed by WHO and UNAIDS, yet their wide-scale implementation remains blocked and limited.
“Effective, proper scale-up of HIV treatment cannot happen with business as usual,”said Dr. Eric Goemaere, MSF’s referent on HIV/AIDS. “The current rhetoric falls short of fully embracing effective and efficient strategies that have proven to work for years already
Since 2007, MSF and other organizations have pioneered a wide array of community strategies to bring treatment closer to people’s homes. By reducing the number of medical visits needed to obtain refills of HIV medicines, for example, MSF and others have been able to decrease the amount of time and money needed to access drugs. More than 90 percent of stable patients enrolled in various types of community models have remained on treatment in South AfricaMalawi , Mozambique, Zimbabwe and Kenya. Pilot programs in countries in West and Central Africa, which are currently lagging behind in their HIV response, such as DRC and Guinea, have also shown good patient outcomes.
Yet the key regulatory enablers that can make those solutions work are not actively supported, promoted and financed. For example, HIV/TB non-medical personnel are often not recognized or funded. Regulations limiting drug refills to as little as one month supplies per person greatly reduce the benefits of these strategies. Governments remain reluctant to give patients the power and responsibility to manage their chronic condition by limiting drug distribution and community HIV testing.
“Community models implies strong, empowered and fully engaged communities of people living with HIV and civil society organizations,”said Amanda Banda, MSF’s HIV advocacy coordinator. “Yet we continue to see decreased funding towards these communities, further undermining patient focus and engagement in the fight on HIV. This is a missing link in the current response. ”
In South Africa, the leading activist group Treatment Action Campaign (TAC) is facing such a severe funding crisis that it faces the threat of closure after 15 years of existence. According to UNAIDs, 59 percent of NGOs working on HIV and human rights saw their funding decrease in 2012.
Community models demand flexibility in the health systems as there is no one size fits all approach. HIV positive people should be given the choice on how to fit their daily treatment within their own lives so thathealth systems and service organizations help, not hinder them. MSF urges governments to adapt their response to the needs and demands of citizens affected, and international partners to proactively support and fund these strategies.
MSF currently supports HIV treatment for 341,600 people throughout 20 countries. 71 percent of the 35 million people living with HIV/AIDS live in sub-Saharan Africa.