As donors retreat from funding HIV and AIDS programmes, years of progress in HIV treatment are under threat and the lives of HIV-positive people are increasingly on the line, according to a new report by the international medical charity, Médecins Sans Frontières (MSF).
Improved access to antiretroviral (ARV) treatment has saved lives, reduced the incidence of tuberculosis (TB) and new HIV infections, and strengthened health systems in many countries hard hit by HIV. But as funding diminishes, these gains are now in jeopardy, says MSF's new report, No Time to Quit: HIV/AIDS Treatment Gap Widening in Africa.
Funding shortages in eight African countries have already led to drug stock-outs, treatment rationing, and the inability of most of the countries to adopt improved ARV regimens advocated by the World Health Organization (WHO), the report noted.
"About 75 percent of HIV funding in developing countries is international – you can't replace that in the short term," said Mit Philips, a health policy analyst at MSF and one of the report's authors.
"Even for South Africa, one of the richest countries in the region, to realise its plans for the fight against HIV it will also have to rely on international assistance."
Donors pull back
The recent decision by the US President's Emergency Plan for AIDS Relief (PEPFAR) to flat-line its funding at 2009 levels and decrease annual budget allocations in coming years, has already led PEPFAR-supported clinics in South Africa to begin turning away patients.
UNITAID, the international drug purchasing facility, is to phase out drug funding, leaving Zimbabwe, Mozambique, the Democratic Republic of Congo (DRC) and Malawi without funding for costly second-line ARV drugs by 2012.
The Global Fund to Fight AIDS, Tuberculosis and Malaria has started accepting applications for Round 10 of funding but has capped funding levels for the first time - a worrying sign that the donor drought may be far from over.
"A moral betrayal"
Dr Eric Goemaere, MSF Medical Coordinator in South Africa, called donor backtracking a "moral betrayal". "Years ago, countries in this region [southern Africa] were unsure that they could afford treatment, but they were told [by the international community], 'Set ambitious targets, we will follow with the money'," he told IRIN/PlusNews.
"If this funding trend is confirmed, I would call it a moral betrayal ... for patients, who we told to be courageous and face testing because we would provide treatment; for the health staff, who managed to enrol more than four million people on treatment, and who are suddenly told not to enrol patients."
The report predicted that if the downward trend in funding continued, ARVs would become increasingly inaccessible, which would lead to increased rates of mortality and hospitalisation among those living with HIV, and place a strain on already weak health systems.
The report also warned that ARV patients may adopt risky strategies for coping with drug supply shortages, such as sharing pills, thereby increasing the likelihood of widespread drug resistance.