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AFRICA: Less Funds Will Cause Unnecessary AIDS Deaths

Nastasya Tay

JOHANNESBURG , Jun 5 2010 (IPS) - Backtracking by international donors in funding the fight against HIV/AIDS risks widening the treatment gap in Africa, undermining years of positive achievements in the field, warns a new Medecins Sans Frontières report. And many more unnecessary HIV-related deaths will be caused by these shifts in international donor funding

A long line of patients at a sexual health clinic in Hillbrow, Johannesburg. Much of this clinic's work is funded by international donors. Credit: Nastasya Tay

A long line of patients at a sexual health clinic in Hillbrow, Johannesburg. Much of this clinic's work is funded by international donors. Credit: Nastasya Tay

Released at the end of May, the report is titled “No time to quit”. And its author, Mit Philips, is extremely worried. Success in the fight against HIV/AIDS is very fragile, she believes.

“How can we give up the fight halfway and pretend that the crisis is over? Nine million people worldwide in need of urgent treatment still lack access to this life-saving care… There is a real risk that many of them will die within the next few years if necessary steps are not taken now,” said Philips.

The flatlining of annual budget allocations for HIV/AIDS, alongside the reduction of the number of donor organisations funding HIV/AIDS treatment in the most affected countries places increasing pressure on already under-resourced health systems.

HIV/AIDS is no longer treated as an emergency. Philips wonders whether speaking too much about success and not enough about the work still to be done has resulted in decreasing public pressure in Europe and the U.S. “In Europe, HIV has become a very treatable chronic disease. It’s hard for people to imagine that it has such a different face in Africa. It’s two different worlds,” Philips said.

Two thirds of people living with HIV in sub-Saharan Africa that need treatment – some six million people – are not getting it. Stock outs in some countries of life-saving anti-retroviral treatment, as well as doubts about future funding have far-reaching consequences for health systems planning, and especially implications for ARV programmes.

The financial crisis and changing approaches to the fight against the disease have resulted in a re-categorisation of funding, away from providing treatment to once-off injections of equipment or infrastructure, thereby avoiding recurrent costs. But those who are already on treatment need the funding to continue for them to be able to receive their medication. And those not on treatment will not be able to access it, unless funding is not only maintained, but increased.

Mark Heywood, deputy chairperson of the South African National AIDS Council believes the issue for South Africa is not about sustaining existing levels of funding, but increasing donor support in order to allow treatment to be scaled up. Currently the country has some one million people on anti-retroviral treatment, but in the next five years, the number will need to rise to approximately five million. This expansion is not something South Africa can afford to fund on its own.

Although the South African government depends less on international donors than some of its neighbours, healthcare is still underfunded.

“But this doesn’t make South Africa a beggar for international charity,” said Heywood. “What it does make clear is that managing the epidemic is an international responsibility. Health is a global duty.”

Ensuring the provision of HIV treatment is not simply a pragmatic question, but also an ethical one. In the context of the South African government’s new mass HIV counselling and testing campaign – the largest of its kind in the world, aiming to test 15 million individuals in a year – can you scale up voluntary counselling and testing without increasing the accessibility and availability of life saving treatment for those who require it?

Donor retreat in South Africa would not be felt only within the country’s borders, but throughout the Southern African region, Heywood believes. Through intricate and complex links with neighbouring countries, including large migrant worker populations, consequences would have a regional impact – not only on HIV treatment, but it also would translate into an increase of tuberculosis and its multi-drug resistant variety.

“There is evidence on a global scale of a retreat – evident that donors are reconfiguring programmes that will take money away. This will result in numerous preventable deaths, and preventable diseases,” Heywood said.

Greater accountability of all actors – donors, governments and recipients alike – is imperative for dealing with the crisis. “I don’t dispute the gross wastage of donor funding in certain places, but ultimately, how do you get out of this cycle of ad hocism and short-sightedness of funding on these issues?” asked Heywood.

Going into a replenishment period this year, the Global Fund is concerned that donor countries may not make the necessary commitments to maintain and scale-up HIV-related programmes. Professor Michel Kazatchkine, executive director of the Global Fund believes the results could be disastrous.

“I am extremely worried about the reports that people are being turned away from treatment centres or put on waiting lists. Donors must allow us to continue scaling up access to treatment and prevention, so that we can ultimately win the fight. Otherwise, AIDS, tuberculosis and malaria will gain force again in South Africa and other countries, which would be a public health and human rights disaster,” Kazatchkine said.

In this funding round, certain donors, including the United Kingdom, Germany and France, want financing capped. UNAIDS estimates that for 2010, effectively combating the pandemic worldwide requires 25 billion dollars, including seven billion dollars for treatment. But only 14 billion dollars has been made available.

“This is no time for us to slow down our efforts. Rather, we should redouble them,” Kazatchkine said.

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