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 amd  USA  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  has 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. ‘€œ(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.

The following statement has been released by the US Embassy:

Pretoria ‘€“ Ambassador Eric Goosby, U.S. Global AIDS Coordinator, stated today, ‘€œFunding for the U.S. President’€™s Emergency Plan for AIDS Relief (PEPFAR) is continuing to increase. The U.S. Government remains committed to the fight against global AIDS, and our support for this effort is deep, strong, and enduring.   PEPFAR is the largest commitment by any nation to combat a single disease in history. The U.S. is and will remain by far the largest donor to global HIV/AIDS efforts, contributing well over half of global donor resources. U.S. funding for PEPFAR has risen from nearly $2.3 billion in FY 2004 (for bilateral HIV/AIDS programs, the Global Fund, and bilateral TB programs) to $6.8 billion in FY 2010. For FY 2011, President Obama has requested nearly $7.0 billion, including $5.74 billion for bilateral HIV/AIDS programs, $1 billion for the Global Fund, and $251 million for bilateral TB programs. In a time of tightening budgets and economic constraints, this request for the eighth year of PEPFAR is the largest request to date in a President’€™s Budget, reflecting the human impact of PEPFAR.   At the same time, HIV/AIDS is a global responsibility, and the U.S. is actively engaging with other donors around creating a response that is truly global.

‘€œPEPFAR programs continue to scale up HIV/AIDS prevention, treatment and care services in countries around the world.   PEPFAR has directly supported life-saving antiretroviral treatment for over 2.4 million men, women and children as of September 2009.   And PEPFAR has directly supported more than 11 million people with care and support programs, including more than 4 million orphans and vulnerable children, through fiscal year 2009. PEPFAR’€™s efforts around prevention of mother-to-child transmission programs have allowed nearly 340,000 babies of HIV-positive mothers to be born HIV-free, including nearly 100,000 in fiscal year 2009.   These results represent men, women and children alive today thanks to international action.’€

MSF Statement:

DONOR RETREAT WIDENS HIV/AIDS TREATMENT GAP IN AFRICA

Johannesburg, 27 May 2010 РBacktracking by international donors in funding HIV/AIDS risks undermining years of positive achievements and will cause many more unnecessary deaths, warns humanitarian aid group M̩decins Sans Fronti̬res (MSF) in a new report.

Titled ‘€œNo time to quit: HIV/AIDS treatment gap widening in Africa’€, the report builds on analyses made in eight sub-Saharan countries to illustrate how major international funding institutions such as PEPFAR, the World Bank, UNITAID, and donors to the Global Fund have decided to cap, reduce or withdraw their spending on HIV treatment and antiretroviral drugs (ARVs) over the past year and a half.

‘€œHow 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 lifesaving care – two thirds of them in sub-Saharan Africa alone. There is a real risk that many of them will die within the next few years if necessary steps are not taken now. Also, the current donor retreat will prevent more people from accessing treatment and will threaten to undermine all the progress made since the introduction of ARVs’€ says Dr. Mit Philips, Health Policy Analyst for MSF and one of the authors of the report.

The US President’€™s Emergency Plan for AIDS relief, PEPFAR, reduced its budget for the purchase of ARVs in 2009 and 2010, and also introduced a freeze on its overall HIV/AIDS budget. Other donors, such as UNITAID and the World Bank, have announced reductions over the coming years in the funding for antiretroviral drugs in Malawi, Zimbabwe, Mozambique, Uganda and the Democratic Republic of Congo (DRC).

The Global Fund, the largest funding institution in the fight against HIV/AIDS, faces a major funding shortfall. The US, the Netherlands and Ireland have already announced that they will be providing lower contributions to the Global Fund. In 2009-2010, contributions to already approved country grants were reduced by 8-12%.

Overall funding cuts have translated into a reduction in the number of people able to start their ARV treatment, as seen in South Africa and Uganda, and in DRC ‘€“ where the number of new patients able to start ARV treatment has been cut six-fold. Already fragile health systems will become increasingly strained by an increasing patient load requiring more intensive care.

Drug stock-outs and disruptions in drug supply are already a reality, and will become more frequent if sufficient funding is not made available. MSF has recently been requested by the government and other actors to assist with emergency drug supplies in Malawi, Zimbabwe, DRC, Kenya and Uganda.

‘€œIf there is reduced funding, then it will mean more people will die, and we will have more orphans. The ones that are positive often need to assist others, like their children. People will lose hope and die. It will be the end. If there are no drugs there is no future’€ says Catherine Mango, an HIV patient from Kenya.

ARV treatment is lifesaving but also lifelong. This means that the number of patients under treatment increases cumulatively each year, thus requiring incrementally growing and sustainable funding.

‘€œThe HIV / AIDS crisis remains a massive emergency that still requires an exceptional response. MSF calls for a sustained and renewed commitment by donors and national governments in the fight against HIV/AIDS, so that this disastrous public health crisis can be addressed appropriately,’€ concludes Dr. Philips.