Punishing Success in Tackling AIDS

Funders? Retreat Could Wipe Out Health Gains in HIV Affected Countries

Johannesburg/New York, November 5, 2009 — 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 released today by the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF).

International support to combat HIV/AIDS is faltering, as reflected in significant shortfalls among two of the world’s main funding mechanisms for HIV/AIDS. The board of directors of the Global Fund, a key financer of AIDS programs in poor countries, is unable to respond to countries’ needs. The board will vote next week in Addis Ababa whether or not to suspend all new funding proposals in 2010. The US President's Emergency Plan for Aids Relief (PEPFAR), the American government’s AIDS program, is capping funding for two more years. This means that new patients will be turned away for treatment.

Report: Punishing Success: Early Signs of a Retreat from Commitment to HIV Care and Treatment.

The MSF report highlights how expanding access to HIV treatment has not only saved the lives of people living with AIDS but has been central to reducing overall mortality in a number of high HIV burden countries in southern Africa in recent years.

In Malawi and South Africa, MSF observed significant decreases in overall mortality in areas with high antiretroviral therapy (ART) coverage. Increased treatment coverage has also had an impact on the burden of other diseases. For example, tuberculosis cases have been significantly reduced in Thyolo, Malawi and Western Cape Province, South Africa.

“After almost a decade of progress in rolling out AIDS treatment we have seen substantial improvements, both for patients and public health,” said Dr. Tido von Schoen-Angerer, director of MSF’s Access to Essential Medicines Campaign. "Recent funding cuts mean doctors and nurses are being forced to turn HIV patients away from clinics, as if we were back in the 1990s before treatment was available.”

“The Global Fund must not cover up the deficit caused by its funders,” said von Schoen-Angerer. “The proposed cancellation of the 2010 funding round and other measures to slow the pace of treatment scale-up are punishing the successes of the past years and preventing countries from saving more lives.”

PEPFAR has had a huge impact on increasing the number of people on AIDS care and treatment in poor countries since 2003, supporting more than two million people on treatment with a commitment to increase treatment to at least three million by 2013. But U.S. government HIV/AIDS funding has remained the same for 2009 and 2010 and early signs indicate there will be no increase in funds for 2011 either. The proportion of PEPFAR’s budged dedicated to treatment has actually decreased. Only a handful of countries will be able to increase the number of new patients at a pace similar to what PEPFAR has supported in the past.

In 2005, world leaders promised to support universal AIDS coverage by 2010, a promise that encouraged many African governments to launch ambitious treatment programs.

"What about the promise made to people with AIDS?” said Olesi Ellemani Pasulani, MSF clinical officer in Thyolo District Hospital in Malawi. “We gave them hope and life. We have to be there for them. We all knew from the beginning that this treatment was for life. Passing on the bill for treating AIDS to very poor countries would be a colossal betrayal.”

Reducing funding at this time will leave people in urgent need of treatment to die prematurely, and can lead to dangerous interruption of treatment.

In Uganda, cuts have already begun to hit home, with some facilities forced to stop treating new patients with HIV. Other countries are backing away from their earlier treatment coverage targets. In Free State, South Africa, past funding problems—since resolved—led to disruption of treatment and a moratorium on treating new patients, which resulted in an estimated 3,000 deaths.

The report provides evidence that treating AIDS, particularly in high prevalence settings, has a positive impact on other important health goals, in particular maternal and child health.

“A stronger commitment to other health priorities must happen, but this should be in addition to, not instead of, continued, increased commitment to HIV/AIDS,” said von Schoen-Angerer.

At present, over four million people living with HIV/AIDS in the developing world receive antiretroviral therapy. An estimated six million people who are in need of life-saving treatment are still waiting for access. MSF operates HIV/AIDS programs in approximately 30 countries and provides antiretroviral treatment to more than 140,000 HIV-positive adults and children.