HEALTH-AFRICA: Phoney Choice Between Life and Death

By Kristin Palitza

Failure to sustain funding for HIV/AIDS treatment programmes could lead to a rising number of deaths, particularly in Africa.

"We need 17 to 18 billion dollars per year, or a total of 123 billion dollars over the next seven years (to fund HIV programmes worldwide), but all we have is $20 billion, leaving us with a funding gap of $103 billion," warned Eric Goemaere, head of Doctors Without Borders in South Africa.

Goemaere was among thousands of researchers, clinicians, policy-makers and community activists attending the Fifth International AIDS Society (IAS) Conference on HIV Pathogenesis, Treatment and Prevention in Cape Town which ends Wednesday.

The U.S. President's Emergency Plan for AIDS Relief (PEPFAR), which contributes more than $3.7 billion to HIV prevention and care globally, has not increased its budget this year, despite president Barack Obama's promise of an annual increase of $1 billion.

Another key global donor, the Global Fund to Fight AIDS, Tuberculosis and Malaria, has announced it is facing a budget shortfall of between three and four billion dollars.

Goemaere said the funding shortfall was particularly tragic because with seven million people in need of antiretroviral (ARV) treatment worldwide, "the need is still increasing, and we promised universal access. It is unacceptable for us to say there is no money internationally."

According to Goemaere, the threat to HIV funding has less to do with the global financial crisis than with a general lack of commitment from some rich nations, such as France and Italy, who provide 0.4 percent and 0.1 percent of all global HIV/AIDS resources, despite the size of their economies.

In Southern Africa, one of the regions hardest hit by the pandemic, the results of the funding cuts from major international donors have already hit home. The Tanzanian government, for example, had to reduce its HIV budget by a quarter, while Swaziland lowered its 2011 treatment coverage target from 60 percent to 50 percent, which will affect about 40,000 HIV-positive people.

Uganda was instructed to stop enrolment in treatment by some PEPFAR-funded non-governmental organisations, and Malawi is expecting national drug shortages and in the process of putting into place an emergency plan.

Hoosen Coovadia, Victor Daitz Professor for HIV/AIDS research at the University of KwaZulu-Natal summed up the situation succinctly: "You can't make phoney choices between life and death. You have to find money."

Coovadia believes that there would be enough money available worldwide to fight the pandemic if governments were implementing health programmes more efficiently. "We have wasted money by not planning and targeting properly. As a result, our services are collapsing. We need real leadership and cost-effective interventions."

Vuyiseka Dubula, general secretary of South African HIV advocacy group Treatment Action Campaign (TAC), agreed with Coovadia that lack of political will in Sub-Saharan Africa is a major stumbling block to treatment access.

"Health budgets are not prioritised. There is poor health planning and spending, combined with poor accountability," she lamented. "Our leadership could do more."

Goemaere called for renewed commitment from international leaders. "We need national and international funding security through five-year plans to create sustainability and ongoing pressure to sustain political will (to support HIV funding)," he said.

"In 2000, [Ugandan HIV specialist Peter] Mugyenyi said treatment exists, but not where the disease is, and unfortunately that’s still true," Goemaere added.

Shortfalls in funding will directly affect HIV disease and mortality rates in developing countries. "We can’t afford to backslide. If we don’t keep up existing programmes and increase coverage (of ARV treatment), we will see tremendous mortality," warned Professor Robin Wood, director of the Desmond Tutu HIV Centre in Cape Town.

"Funding may not dry up. Otherwise we will see drug stock outs, which will lead to viral suppression and we will lose the viability of first-line treatment," he said.

First-line antiretroviral (ARV) drugs are a set of three, highly efficient drugs to treat HIV. If patients default from their treatment regimen due to drug shortages, they may become immune to some of the first-line drugs and have to rely on a second-line treatment, made up of different drugs, which are less effective, have more side effects and are six times more expensive than first-line ARVs.

"Delays of putting patients onto treatment has dire consequences. Almost a quarter will not come back [once ARVs are available], 22 percent will die and the cost of health services will increase because they will fall ill," warned Wood. "That’s a disaster."

This year, temporary ARV stock-outs have already occurred in numerous Sub-Saharan countries, including South Africa, Uganda, Malawi and Nigeria.

"Stock-outs are a management failure and a human rights violation that is unacceptable," said Anglo American chief medical officer Brian Brink.

"The economic recession cannot be an excuse to slow down on treatment. If we don’t continue to provide treatment, it's going to cost a whole lot more in the long-term."