There is a real risk of losing ground in the fight against global HIV/AIDS if funding for key programs is not increased, according to a new report published by Medicins Sans Frontieres (MSF) called, “Reversing HIV/AIDS? How Advances are being Held Back by Funding Shortages.” Funding shortages threaten to set back progresses made in many countries as national treatment programs are under threat of being severely curtailed. According to the report, now more than ever scientific evidence promises to stem the epidemic, and donors must maintain their funding commitments in order to continue progress and bring an end to the epidemic. The report attempts to explain what has happened, and why and how these cuts are affecting the countries where MSF works.
The recent HIV Prevention Trials Network (HPTN) 052 study demonstrated that antiretroviral therapy (ART) saves lives and prevents new infections. In light of this, United Nations member states set a new target in June to increase the number of people on HIV treatment from 6.6 million today to 15 million by 2015. In addition, the U.S. has made the goal of “turning the tide on AIDS” official government policy. Despite promising scientific advancements and political commitments, funding for HIV/AIDS is declining. According to the report, “There is therefore a significant incongruence between what can and should be done, and the funding made available to get it done.”
The report makes clear that due to budget constraints, several countries have already been forced to scale back national plans, including implementation of the World Health Organization (WHO) 2010 recommendations and accelerated treatment strategies. With the Global Fund to Fight AIDS, Tuberculosis, and Malaria making a recent announcement that Round 11 funding has been cancelled, developing countries are even more at risk of reversing the progress made against HIV/AIDS.
The report includes in-depth country profiles on the current state the HIV treatment programs and what the impact of a drop in Global Fund financing will mean to these countries where MSF works: The Democratic Republic of Congo, Kenya, Lesotho, Malawi, Mozambique, South Africa, Swaziland, Uganda, Zambia and Zimbabwe. Here are highlights from a few a few of them:
Democratic Republic of Congo (DRC): “HIV treatment and care in the DRC is in the grip of a downward spiral caused by funding shortfalls and disbursement delays.”
- Only 12 percent of those eligible for ART are receiving it, leaving 300,000 people without access to treatment.
- Only two percent of pregnant women infected with HIV have access to prevention of mother-to-child transmission (PMTCT) services.
- Initiation of ART was capped at 2,000 new patients in 2011, even though 15,000 people were on waiting lists, attributable to funding shortfalls for Global Fund grants.
- Funding for ART comes largely from the Global Fund, and due to the Fund’s financial difficulties, the DRC is scaling back the size of their grant requests, hoping to increase their chances of getting a piece of a smaller pie; this will result in longer delays for new patients seeking treatment.
- Local organizations have been forced to shut down treatment sites, and the Ministry of Health has asked several NGOs to limit HIV testing because funding for drugs to treat those found eligible is not available.
Malawi: “Malawi’s future funding situation is extremely precarious.”
- 10 percent of the population is infected with HIV/AIDS.
- 67 percent of people eligible for ART are receiving it.
- Malawi has adopted WHO guidelines to initiate ART at CD4<350 and has also followed WHO recommendation for treatment with tenofovir, but has had to scale back implementation of the new drug regimen due to funding shortages.
- Due to persistent internal economic constraints, Malawi is almost entirely dependent on external funding for its HIV response.
- Much of Malawi’s HIV funding comes from the Global Fund and several planned initiatives – such as scaling up medical male circumcision and improved early infant diagnosis – have been scaled back due to lack of funding
Mozambique: “Mozambique is expected to face shortages of first-line antiretrovirals by the end of 2012, or even earlier – unless an emergency funding request to the Global Fund is approved.”
- Only 30-40 percent of those eligible for ART receive ART, leaving more than half a million people without access.
- Mozambique has not been able to adopt the latest WHO guidelines for HIV treatment due to funding and health system constraints, including a severe shortage of health care workers and a weak drug supply chain.
- The country aims to further integrate HIV and TB care, and train and hire more health care workers, but is constrained by funding shortages.
- Mozambique faces a severe funding gap, as 96 percent of the HIV budget is donor-funded with the Global Fund and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) providing the most funds.
Zimbabwe: “Many programs are threatened by a lack of funding and program closures.”
- One million adults and 150,000 children are living with HIV/AIDS.
- 63 percent of those eligible for ART are on treatment, up from five percent in 2006.
- Increased ART coverage has reduced annual AIDS deaths by 42 percent since 2006.
- The National HIV and AIDS Strategic Plan for 2011-2015 calls for treatment to be available for 85 percent of those eligible by 2015. This would reduce annual deaths by another 27 percent.
- Zimbabwe also aims to circumcise 1.2 million men by 2015, resulting in a 25 to 35 percent reduction in HIV transmission
- Funding shortfalls threaten to interrupt treatment for patients already on ART: ARV shortages are predicted to affect 86,500 patients in 2012, and 112,800 patients by 2014.