Integrated Regional Information Networks - November 5, 2009

In a report called "Punishing Success? Early signs of a retreat from commitment to HIV/AIDS care and treatment", released on 5 November, MSF highlights worrying indications that the two biggest international funders helping developing countries expand their AIDS programmes are starting to scale back or flatline their contributions.

The board of the Global Fund to Fight AIDS, Tuberculosis and Malaria, which largely relies on money from developed countries to award grants in 140 poor countries, will soon decide whether to cancel its 2010 call for funding proposals.

If so, it will be the organization's first year since 2002 without a funding round; the total amount of HIV grants recommended for funding in 2009 was 35 percent lower than in 2008.

Countries like Malawi are heavily dependant on Global Fund grants to finance their antiretroviral (ARV) treatment programmes. The MSF report notes that with the Fund in crisis, Malawi's chances of achieving universal access to treatment are sinking.

The US President's Emergency Plan for AIDS Relief (PEPFAR), under the leadership of former President George Bush committed to scaling up treatment from the more than two million people it supports to at least three million by 2013.

Now, faced with an economic crisis, President Barack Obama's administration has flatlined US funding for HIV/AIDS in 2009. In Uganda, a principal beneficiary, some PEPFAR-supported organizations have stopped putting new patients on ARVs.

"We're launching this report because we think we're at a very dangerous turning point," said Dr Tido von Schoen-Angerer, director of MSF's Access to Essential Medicines campaign. "Critical decisions are being made by governments and we're starting to see the early effects on the ground."

After leading the charge for universal access, the UK Department for International Development (DfID) has started redirecting funds to other health issues, while Netherlands is considering a reduction of 30 percent in its HIV/AIDS spending.

"The message five years ago was 'Go for it and we'll support you'," said Dr Eric Goemaere, MSF medical coordinator for South Africa and Lesotho. "Now that we're midway across the river, they seem less sure."

Von Schoen-Angerer was critical of the recent trend in global health policy of pitting AIDS against other health priorities, such as maternal and child health. He pointed out that AIDS was "a continuing emergency" and accounted for more than half of all deaths in five of the countries with the highest HIV prevalence.

"Clearly, there are other global health needs, but it can't be an either-or game," he said. "The dirty secret here, I think, is that donors are getting cold feet about funding a long-term chronic disease."

The decision by some donors to shift funding out of HIV/AIDS treatment and into prevention also created what Goemaere called "a false dichotomy" - for instance, areas like South Africa's Western Cape Province, which had achieved high levels of treatment coverage, were seeing the greatest drop in HIV infection.

Von Schoen-Angerer warned that the cost of treatment was set to rise in coming years. The World Health Organization is considering revising guidelines to reflect research findings that starting ARV treatment earlier improves survival rates and reduces the incidence of opportunistic infections. This could effectively double the number of patients who qualify for treatment.

A growing number of patients will also need second-line ARV drugs, which are currently much more expensive than first-line medications.

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