South Africa is not spared from the financial crisis. Recently, the Treasury had to find R900 million in the government’€™s coffers to give life to the country’€™s ailing AIDS treatment programme. This averted a national disaster as all provinces were running short of cash to buy drugs. A situation similar to the Free State province, which placed a moratorium on enrolling new patients on its antiretroviral treatment programme last year, was looming. Government was short of R1.2 billion to meet the demand for ARVs, this year. The remainder of the deficit, R300 million, is coming from unspecified donors. This shows that in these tough economic times, even a relatively rich African country like South Africa cannot be financially self-sufficient. External funding is crucial to ensure that we realise targets set out in the National AIDS Strategic Plan. But external funding for AIDS is shrinking. And that spells disaster for countries dependent on donor funding, according to Sharonann Lynch, policy advisor for international humanitarian agency, Medecins Sans Frontieres (MSF) or Doctors without Borders.

‘€œWe’€™re going to see the donor changes impact on the ground more and more. But already disturbing signs include countries that are saying ‘€˜without more’€™ they ‘€˜cannot meet universal targets’€™. That includes Swaziland, Tanzania, Botswana and, until recently, South Africa, although, thankfully, something has been done there’€, she says.

The MSF recently reported that two key international programmes supporting AIDS treatment in the developing world are not increasing their funding commitments to meet the rising demand for ARV treatment. For two successive years the Global Fund Against AIDS, Tuberculosis and Malaria has reduced funding for approved grants, while the American President’€™s Emergency Plan for AIDS Relief (PEPFAR) is now practicing what it calls ‘€œflat-funding’€.

‘€œIn 2010, PEPFAR will not have received new money from 2009. In effect, it has been flat-funded. We’€™re told by White House in the US that the budget coming from the White House to Congress this month will also have a flat-funding of PEPFAR for 2011. This will all have disastrous effects for the countries that have been relying upon PEPFAR funds’€, says Lynch.        

‘€œWhen you flat-line and the needs are increasing, it means that you can only recruit when someone dies, when someone empties a seat or a treatment slot’€, explains Dr Erci Goemaere, co-ordinator of MSF missions in South Africa and Lesotho.

Inevitably, the funding crisis will lead to the reversal of gains made since the start of antiretroviral treatment in developing countries.    

‘€œWhere there is good ART coverage, we’€™re starting to see a reduction of AIDS-related mortality. We’€™re also starting to see a reduction in overall population mortality, a reduction in maternal mortality, a reduction in under-five mortality and a reduction in new cases of TB’€, says Lynch.

Dr Eric Goemere Goemaere called the pulling away of funds from supporting AIDS programmes in the developing world ‘€œa betrayal of trust’€ by the international community which committed to help poor nations reach universal access to AIDS treatment by 2010.

‘€œThe message five years ago was very clear: ‘€˜Be ambitious’€™. ‘€˜Scale up’€™! ‘€˜We commit to universal coverage by 2010’€™. There was a very strong message to the countries in the region, and many of them extremely poor countries: ‘€˜Go for it and we will support you’€™.   Today, there is a message that’€™s saying: ‘€˜Well, we are not sure that we can support you’€™. This would be an international betrayal’€, he said.

The MSF calls on the super-powers of the world ‘€“ America and Britain – not to abandon the supportive roles they have played in the response to AIDS. The former president of America led the call for universal access to treatment by establishing PEPFAR in 2003. The former British Prime Minister led the call for universal access to treatment within the Group of 8 wealthy countries, which was then endorsed by the United Nations’€™ General Assembly in 2005 and 2006.    

‘€œWe’€™d like to acknowledge that there indeed a financial crisis, but there is also a very political crisis where there are choices being made in terms of what to fund. And, frankly, there is a new generation of political leaders in place. You had Tony Blair and George Bush lead on universal access to treatment on behalf of wealthy countries. The new political generation cannot throw off that mantle of leadership. We cannot remove ourselves from the commitment to universal access as if it’€™s a red ribbon lapel pin that you can wear one day and take off the next’€, says Sharonann Lynch, policy advisor for Medecins Sans Frontieres.