What does flat funding for PEPFAR and other global AIDS programs mean on the ground in places like the Democratic Republic of Congo? Fewer new treatment slots. Uncertainty about access to lifesaving drugs. An unfolding crisis.
That’s one snippet in a bigger, disturbing picture painted by a new report from Doctors Without Borders, or MSF. The medical humanitarian group conducted an in-depth field analysis in 8 countries to determine the ramifications of an international pullback from the global AIDS fight.
“The findings confirm our concerns in terms of donor backtracking on commitments to scale up the fight against the HIV/AIDS epidemic,” the report states. “Today, this disengagement is starting to become visible in the field and the level of HIV care is beginning to deteriorate.”
The situation in the DRC is one of MSF’s case studies. The report notes that currently, only about 12 percent of HIV-infected persons in that country are getting the lifesaving drugs they need. And that’s according to the old WHO guidelines, which have been updated to recommend earlier initiative of HIV therapy. Furthermore, only 2 percent of pregnant women in the DRC have access to prevention of mother-to-child HIV transmission services.
Despite the clear need, many donors now working in the DRC are cutting back. For example, the report says that PEPFAR is going to stop purchasing drugs for opportunistic infections, needed by those with HIV due to their compromised immune systems, and hand over this expense to the Global Fund. But the Global Fund may not be equipped to take on this and other burdens as PEPFAR, the World Bank, and others seek to transition their roles.
“In 2009, the Global Fund was supporting 1,000 new initiations per month,” the report says. “now the revised availability of funds for initiation has been cut six-fold to 2000 per year. The consequence is that in DRC—in spite of the acute crisis situation—dramatically fewer patients can start ARV.”