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 by Médecins Sans Frontières (MSF).
The report highlights a number of signs that donor commitment towards the scale-up of antiretroviral therapy is faltering.
Although many countries have been successful in scaling up treatment services to provides antiretroviral treatment to people in need, few countries have yet achieved the target of `universal access` - diagnosis and treatment of at least 80% of people with HIV with an immediate need for treatment.
According to a recently published report from WHO, UNAIDS and UNICEF, only 42% of people in need of treatment in low and middle-income countries are currently getting it. Nearly five million people are currently in need of treatment.
Loss of momentum in scale-up will lead to continuing high levels of death and illness, and even the erosion of recent gains deaths averted and TB cases prevented, MSF argues.
Major donors are facing significant problems in expanding their commitment, due in part to the economic crisis, but also due to reluctance to devote further resources to HIV treatment at the expense of other health problems.
In the case of the Global Fund to Fight AIDS, Tuberculosis and Malaria, MSF notes that while in 2008 the Fund’s board encouraged ambitious country proposals for scale-up, resulting in a 2.5-fold increase in grants, 2009 grants have fallen by 35% compared to 2008 due to a shortfall in donor support for the Fund.
The Fund announced in March 2009 that it faced a $4 billion shortfall, due in part to the failure of major industrialized countries such as France, Germany, Japan and Italy to make commitments commensurate with their GDP.
The Fund has also imposed a 10% cut in grants already approved, and is considering whether to abandon the automatic extension of grants to programmes that have performed well.
Next week in Addis Ababa the Global Fund’s board will vote on whether or not to suspend all new funding proposals in 2010.
In the United States funding for PEPFAR will be frozen at current levels for the next two years, indicating that no further expansion of treatment numbers will be possible.
Governments such as those of Malawi and Uganda are now searching desperately for funds to treat the growing number of people with HIV who will require treatment in years to come.
But the report also notes the failure of most African governments to meet a 2001 pledge to devote 15% of resources to health – only eight have reached this target.
“After almost a decade of progress in rolling out AIDS treatment we have seen substantial improvements, both for patients and public health. But 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”, says Dr Tido von Schoen-Angerer, Director of MSF’s Access to Essential Medicines Campaign.
“The Global Fund must not cover up the deficit caused by its funders”, says 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.”