Over the last decade, antiretroviral treatment (ART) scale-up to millions of people living with HIV/AIDS in developing countries has been possible thanks to a massive mobilisation of resources and political will, the simplification of ART, and the competition among drug manufacturers that has pushed prices for AIDS medicines down by more than 99% since 2000. More than four million people are alive today who without treatment would not be, and epidemiological trends show crucial progress in the battle against the epidemic. MSF currently provides ART to more than 162,000 people in 25 countries.

The World Health Organization (WHO) has recently made important changes to treatment guidelines, and now recommends that people be provided with treatment earlier, before the disease is allowed to progress. This would bring clinical practice in developing countries closer to standards long adhered to in wealthy ones. In addition, new evidence shows that wide-scale and early treatment may be an effective way to curb transmission of the virus at population level.

But despite evidence of the broad benefits of ART, we are witnessing alarming backtracking just as efforts should be ramped up. Donors have started to shift their support away from HIV/AIDS, and funding is not keeping up with the need. MSF has seen the negative impact this is already having in some countries: care is being rationed because of limited treatment slots, slowing treatment scale-up for those in urgent need, and threatening the lifeline of those fortunate enough to be on treatment. Today, ten million people are in immediate need of treatment 2 – if nothing is done, most of these people will die within the next few years. 2010 brings us to a critical crossroads that will determine the size and pace of the AIDS response for the coming years. Donors will make the political choice to either fulfil their commitment to universal access to ART as promised in 2005, or to continue down the path of disengagement.

This document illustrates ten consequences of the funding retreat for people living with HIV/AIDS in developing countries, drawing upon data from MSF field research released at the XVIII International AIDS Conference (IAC) 2010 in Vienna, and experience providing ART over the last ten years.

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