African countries such as Zimbabwe, Mozambique, Malawi and the Democratic Republic of Congo are examples of how disinvestment in AIDS can scupper AIDS programmes in the developing world and put the lives of millions of people at risk. In Malawi, for example, about one million people have HIV and 350 000 are receiving antiretroviral treatment. The country’s total health budget is 90 million US dollars and the total cost of its ARV treatment programme is 60 million US dollars this year alone, so it faces a challenge of how to sustain coverage of treatment.
‘We have a dilemma’, says Stuart Chuka, the ARV programme co-ordinator in Malawi’s Ministry of Health.
‘Our dilemma is beyond 2014. We have funding up to 2014. By 2014, Malawi will have about 500 000 patients alive and receiving treatment the way we’re scaling up the services and we’ll be looking at the sustainability of these 500 000 patients that are going to be on treatment beyond 2014. If funding reduces, that will be the collapse of the programme’, Chuka says.
Malawi relies on the Global Fund to fight Aids, TB and Malaria for its ARV programme. In Zimbabwe, about 480 000 people are on treatment. While the country feels the pressure to initiate more people on treatment, many cannot be accommodated due to scant financial resources. Oscar Mundida is from Zimbabwe’s National AIDS Council.
‘On average, we are initiating 8 000 new clients every month. However, we have got a gap of 60 000 people living with HIV who need ART but who cannot be catered for under the current support mechanisms’, Mundida says.
Zimbabwe relies on the Global Fund to fight AIDS, TB and Malaria to support part of its AIDS programme. The country has also brought domestic funding through the National AIDS Trust Fund (NATF), a tax-based funding mechanism to fund AIDS treatment. But with high unemployment levels in Zimbabwe, the NATF is not collecting as much money as needed. Mozambique, on the other hand, is completely dependent on donor support and the prognosis for its AIDS programme is also precarious.
‘We have 1.4 million people living with HIV and AIDS. It is estimated that out of it, 615 000 are in need of ARV treatment. However, only 270 000 are getting it. In every 5 children 4 don’t get treatment. ARV drugs in Mozambique are fully funded by donors. Our health budget is only 7.2% of the total State budget. As civil society we want to see the government of Mozambique increase its contribution for health from the current 7.2% to 15% as committed in the Abuja Declaration. We want donors not to abandon thousands and millions to death because if donors leave it’s over’, says Linda Chongo, the Advocacy Officer for MONASO, the National Network of AIDS Service Organisations.
In the Democratic Republic of Congo (DRC) Medicins Sans Frontieres (Doctors Without Borders) say donor support is non-existent, with the exception of the Global Fund.
‘There are one million people living with HIV in DRC, but there is very limited international donor support for access to treatment. There is 87% of the people in need of treatment who haven’t accessed it yet. Ninety-four percent of the pregnant women have not accessed PMTCT ‘ the prevention-of-mother-to- child transmission programme in DRC. The HIV-free generation is far from DRC where 2 000 children (are) born with HIV every month’, according to Thiery Dethier, of the MSF mission in the DRC.
For all these countries, it is almost impossible to raise domestic money for their own AIDS response. Dwindling donor support means the world has little money to prevent and manage HIV infection. Currently, the World Health Organisation estimates that there is 16 billion US dollars to deal with the epidemic worldwide. About 6 ‘ 8 billion US dollars is still needed for the AIDS response this year.
‘It will require a tremendous financial effort. We speak about 22 ‘ 24 billion US dollars per year. We are very short of that, with our 16 billion. These figures are coming from WHO (World Health Organisation). Scientifically, we know how to wipe out this epidemic. But political commitment will decide. It will decide whether or not it’s good news for everybody or it will only be for the one who can afford it’, warns Dr Eric Goemaere, HIV and TB advisor for MSF Southern Africa.