Health-e (Cape Town)

27 May 2010

Africa: ARV Donor Money Running Dry

Photo: Daily Nation
Aids pills.

Donors are disengaging from the fight against HIV/AIDS leaving behind millions who are still in dire need of lifesaving treatment in South Africa and other hard-hit Sub-Saharan African countries, warned Médecins Sans Frontières (MSF).

The Doctors without Borders group, which is supporting the care and treatment of more than 160 000 people in 27 countries, stated in Johannesburg yesterday (THURSDAY) that the continued support of people receiving treatment was only possible with donor support and a reversal would lead to excessive loss of life.

However, MSF's experience at the coal face is revealing that in most of the eight countries analysed donors were either flat-lining or decreasing their involvement in HIV/AIDS. In its report No time to quit MSF's analysis from eight countries reveals that the donor disengagement was starting to become visible in the field and the level of HIV care was beginning to deteriorate.

This is threatening to undermine all positive effects the high coverage of antiretroviral treatment brings in terms of a reduction in mortality, morbidity and transmission.

Sub-Saharan Africa is home to two-thirds of all HIV positive people worldwide. HIV prevalence rates in some countries in southern Africa have exceeded 20% and in 2008 nearly three-quarters of all HIV/AIDS deaths worldwide occurred in this region.

Today some three million people are receiving ARVs seeing substantial reductions in illness and death where treatment access has increased. However, too many people still die needlessly because they still do not have access to treatment.

Latest estimates are that nine-million people in need worldwide are not receiving ART.

Since last year contributions to the Global Fund to fight Tuberculosis, HIV/AIDS and Malaria (GFATM) from major donors have stagnated. Recently The Netherlands, Ireland, USA and Germany have all announced reductions in the contributions to the Global Fund.

Payments from the USA, France, Italy and Canada are behind schedule and 2010 pledges have not yet been paid. The European Community and Germany have only paid half of their committed contributions so far.

Based on country-defined targets the Joint United Nations Programme on AIDS (UNAIDS) estimated that approximately U$25,1-billion would be required for the global AIDS response for low and middle income countries in 2010. The overall funding available for HIV/AIDS has reached about half that amount.

One of the largest HIV treatment funders, the US President's Emergency Plan for AIDS Relief (PEPFAR) has effectively been flat-lined for 2009 and 2010 with similar proposals for the following years. MSF said PEPFAR aims to pass on the responsibility of direct funding treatment for patients to countries whenever possible, or else to the Global Fund.

As a result some scale up is being halted with little or no warning and with dramatic consequences for those seeking treatment, thus putting enormous pressure at service delivery points.

MSF said that in Mozambique, PEPFAR has announced it will reduce its ARV supplies by between 10 and 15% each year over the next four years. The opening of new antiretroviral treatment sites under PEPFAR funding was also rejected.

In South Africa, ARVs and drugs for opportunistic infections, and laboratory supplies, previously provided by PEPFAR to private ART treatment sites, will now have to be supplied by government. This has resulted in inconsistent supply.

MSF said several PEPFAR-funded sites in South Africa have been halting or limiting ART initiation following instructions to cut expenses in view of flat-lined budgets. In Mpumalanga about 240 patients were refused ART initiation between November 2009 and February 2010.

In the Free State the continuation of treatment for 2 500 patients in private facilities and at general practitioners is presently at stake.

In Uganda, less money has also translated in less treatment slots for adults and children. MSF said that in Zimbabwe, Uganda and South Africa pregnant women and children were receiving priority while other adults were only helped once their CD4 counts (measure of immunity - treatment should start when it dips below 350) dip below 50. "(This) is effectively a policy of encouraging people to fall ill, mostly frequently with TB, before providing them ART," MSF said.

The World Bank's Treatment Acceleration Project ended in 2008 and its Multi-country HIV/AIDS Programme for Africa is coming to an end in several countries, with no plans for any HIV/AIDS specific continuation programme.

The UNITAID/Clinton Health Access Initiative (CHAI) is phasing out its funding of HIV drugs and commodities. By 2012 UNITAID/CHAI procurement of second line ARVs and paediatric medical supplies will end in Zimbabwe, Mozambique, the Democratic Republic of Congo and Malawi.

Finally, HIV/AIDS funding by the European Commission and the European Union's Member States, all together amounts to 4,9-billion Euros, from which overall 1,2-billion Euros goes to the Global Fund.

However, indications are that many of these countries are withdrawing from funding health projects altogether.

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