Pressure growing on wealthy nations for clear signal on long-term funds for HIV

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Pressure is building on governments of wealthy nations to make clear where they stand on funding their promises to achieve universal access to HIV treatment, care and prevention, following a meeting of ministers and civil society advocates from countries with high HIV burdens in London this week.

Donor governments are due to convene in The Hague on March 24th to discuss how they will support the Global Fund to Fight AIDS, Tuberculosis and Malaria over the next few years.

According to figures released on Monday the Global Fund has provided antiretroviral treatment for 2.5 million people, funded the treatment of 6 million TB cases and supported HIV testing and counselling for 105 million people.

Glossary

malaria

A serious disease caused by a parasite that commonly infects a certain type of mosquito which feeds on humans. People who get malaria are typically very sick with high fevers, shaking chills, and flu-like illness. 

drug resistance

A drug-resistant HIV strain is one which is less susceptible to the effects of one or more anti-HIV drugs because of an accumulation of HIV mutations in its genotype. Resistance can be the result of a poor adherence to treatment or of transmission of an already resistant virus.

However the Global Fund faces a significant shortfall in funds as demands rise. During the 2008-2010 funding period the Fund was able to disburse $10 billion, but if demand for treatment and care keeps growing at the current rate, $17 billion will be needed to support existing programmes and new grants in the period 2011-2013, rising to $21.4 billion in the period 2014-2017.

A significant expansion of activity resulting in substantial progress towards the Millenium Development Goals on health would require $20 billion over the next three years, and $27 billion in the period 2014-2017, according to a resources scenario published this week by the Global Fund.

Resources needed in 2011-13

Response achievable at this level of funding

Consequences

Scenario 1: $13 billion

STAND STILL

Continue funding existing programmes

  • 4.4 million on treatment, compared to 2.5 million in 2009 (20% of universal access target)
  • 390,000 AIDS deaths averted in 2015
  • PMTCT reaching 44% of women in need
  • Limited scale up of prevention
  • Not all high-quality proposals would get funded
  • Everyone who needs TB treatment receives it

Scenario 2: $17 billion

KEEP ON THE SAME TRACK

Continue funding existing programmes and expand treatment and prevention on current trajectory

  • 5.8 million on treatment (27% of universal access target)
  • 550,000 AIDS deaths averted
  • PMTCT reaching 58% of women in need
  • Everyone in need of TB treatment receives it

Scenario 3: $20 billion

STEP UP THE RESPONSE

Continue funding existing programmes and scale up high-performing programmes substantially

  • 7.5 million on ART (34% of universal access target)
  • 600,000 AIDS deaths averted
  • PMTCT reaching 76% of women in need
  • Everyone in need of TB treatment receives it

“A world where no children are born with HIV is truly possible by 2015,” says Professor Michel Kazatchkine, Executive Director of the Global Fund. “It is also possible now to imagine a world with no more malaria deaths, since already an increasing number of countries have been reporting a reduction in malaria deaths of more than 50 percent over the past couple of years. No other area of development has seen such a direct and rapid correlation between donor investments and live-saving impact as these investments in fighting AIDS, TB and malaria.”

The London meeting, convened by British international development minister Gareth Thomas, reviewed what is needed to speed up progress towards universal access.

Leaders of the G8 group of industrialised nations agreed to work to achieve universal access to HIV treatment, prevention and care at the Gleneagles G8 summit in 2005.

Progress reports by UNAIDS show that only one-third of those in need of treatment currently receive it, and the recent revision of World Health Organization guidelines to encourage earlier treatment has doubled the number eligible for treatment worldwide.

“A promise that was made to Africa is being broken,” said Vuyiseka Dubula, General Secretary of South Africa’s Treatment Action Campaign.

"Although the world is less than halfway to achieving universal access goals, funders appear to have thrown in the towel and begun to shift their attention elsewhere," said Paula Akugizibwe of AIDS and Rights Alliance for Southern Africa (ARASA). “But the 10 million people in need of treatment can’t be placed on hold much longer by world leaders.”

"An estimated 94 percent of patients on antiretroviral treatment in Africa count on external donor funds to provide their medications," said Michel Sidibe of UNAIDS earlier this week. "If we stop now, if we reduce the financing, the people who are on treatment today ... we will transform their hope for universal access into a universal nightmare, because they will start dying," Sidibe said.

“Instead of building on progress, some donor nations and governments of highly affected countries are backing away from the universal access commitment with a series of poorly funded half-measures on AIDS,” said Robin Gorna, executive director of the International AIDS Society.

”The situation is now an emergency. New treatment enrolments in many countries are coming to a standstill, the risk of drug resistance is increasing, and fragile gains made over the last 10 years may soon erode, with potentially serious consequences for future efforts to control this epidemic.”

"As the economic downturn squeezes the health budgets of the world’s poorest countries, efforts to tackle HIV and AIDS – particularly amongst those who are marginalised and discriminated against - are being hit hardest.

"As a consequence we face the very real prospect that progress on tackling HIV will go into reverse," said Gareth Thomas. He called for G8 countries to recognise the devastating impact unmet financial commitments have on global health, and to live up to their financial pledges to the Global Fund for HIV, TB and Malaria.

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