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Punishing Success? Early Signs of a Retreat from Commitment to HIV/AIDS Care and Treatment

INTRODUCTION
Over the past decade, enormous financial and technical resources have been mobilised globally to address the HIV/AIDS crisis on a large scale. Médecins Sans Frontières (MSF) has seen first-hand the achievements, as well as some of the shortcomings, of these efforts in the course of providing care and treatment in more than 30 countries.
The good news is that four million HIV-positive people are alive on antiretroviral therapy (ART). The scale-up of ART in developing countries has allowed individuals to live longer and enjoy a better quality of life, leading to a restoration of dignity and autonomy, and an ability to contribute to family and societal life.  In some countries, ART coverage has resulted in a decline in overall mortality and other population-level impacts. (See box)
But there is also bad news. Today, MSF teams working to treat HIV/AIDS are witnessing worrying signs of waning international support to combat HIV/AIDS. In some high-burden countries, patients are being turned away from clinics, and clinicians are once again being forced into the unacceptable position of rationing life-saving treatment. At the same time, more robust and better-tolerated treatments – widely prescribed in wealthy countries – are not reaching patients.
The most glaring sign of the decreasing political commitment to HIV/AIDS is a major funding deficit. The Global Fund to Fight AIDS, Tuberculosis and Malaria Board is considering a motion to cancel the funding round (Round 10) for 2010; if accepted, no new proposals will be considered until 2011. Similarly, the US President’s Emergency Plan for AIDS Relief (PEPFAR) plans to “flat-fund” its programs for the next two years, reneging on promises made last year to support expanded treatment access.
Meanwhile, a dangerous trend is underway in the global health policy arena. Rather than looking for ways to leverage and replicate the success of the AIDS public health revolution to improve global health, there are increasing calls for a diversion of foreign aid away from HIV/AIDS and toward other health priorities. While there is clearly a need to give urgent and additional resources to an array of global health priorities, not least maternal and child health, cutting HIV/AIDS funding is not the answer.
Reducing funding at this juncture would not only undermine the goal of reducing maternal and child mortality, but it could also lead to the interruption of treatment for people with HIV/AIDS already on ART, and leave those still in need of access to treatment to die premature, avoidable deaths.
HIV/AIDS is the leading cause of mortality among women of child-bearing age worldwide and responsible for more than 50% of mortality in five of the countries with the highest HIV prevalence. This killer disease is an ongoing emergency that requires dedicated resources at the national and international levels. A strengthened commitment to other global health priorities must happen – but it must happen in addition to, not instead of, a continued and increasing commitment to HIV/AIDS.
This sustained support is essential both for the four million people already on treatment and the estimated six million people who currently need treatment in low and middle-income countries and still do not have access to it. Such support will also help reduce the burden of a number of other health concerns.
CONCLUSION: ADDRESSING THE FUNDING CRISIS
Global health remains underfunded. MSF has repeatedly called for increased global support for a number of pressing health needs such as childhood and maternal malnutrition, vaccinations, tuberculosis, and neglected tropical diseases. However, such efforts should not come at the expense of HIV/AIDS funding and programming: this will undermine opportunities for synergies between HIV/AIDS and other, often linked, health needs.
Funding for HIV/AIDS treatment is not keeping up with need, and appears to be shrinking. Funding shortfalls punish the early success of the last decade of ART scale-up, and threaten to have a devastating impact on people living with HIV/AIDS as well as efforts to prevent new infections. As global health actors retreat from providing direct support for AIDS treatment, more demand is placed on the Global Fund, which is itself critically underfunded.
In order to expand and sustain HIV/AIDS care and treatment worldwide MSF recommends:
    * Sustained and increased funding for HIV/AIDS from the international donor community and national governments – and a continued commitment to universal access to AIDS care and treatment
    * Improved treatment in line with scientific evidence and recognised international standards of care
    * Measures to ensure that prices of drugs and diagnostics remain within reach of poor countries

Over the past decade, enormous financial and technical resources have been mobilised globally to address the HIV/AIDS crisis on a large scale. Médecins Sans Frontières (MSF) has seen first-hand the achievements, as well as some of the shortcomings, of these efforts in the course of providing care and treatment in more than 30 countries.

The good news is that four million HIV-positive people are alive on antiretroviral therapy (ART). The scale-up of ART in developing countries has allowed individuals to live longer and enjoy a better quality of life, leading to a restoration of dignity and autonomy, and an ability to contribute to family and societal life.  In some countries, ART coverage has resulted in a decline in overall mortality and other population-level impacts. (See box)

But there is also bad news. Today, MSF teams working to treat HIV/AIDS are witnessing worrying signs of waning international support to combat HIV/AIDS. In some high-burden countries, patients are being turned away from clinics, and clinicians are once again being forced into the unacceptable position of rationing life-saving treatment. At the same time, more robust and better-tolerated treatments – widely prescribed in wealthy countries – are not reaching patients.

The most glaring sign of the decreasing political commitment to HIV/AIDS is a major funding deficit. The Global Fund to Fight AIDS, Tuberculosis and Malaria Board is considering a motion to cancel the funding round (Round 10) for 2010; if accepted, no new proposals will be considered until 2011. Similarly, the US President’s Emergency Plan for AIDS Relief (PEPFAR) plans to “flat-fund” its programs for the next two years, reneging on promises made last year to support expanded treatment access.

Meanwhile, a dangerous trend is underway in the global health policy arena. Rather than looking for ways to leverage and replicate the success of the AIDS public health revolution to improve global health, there are increasing calls for a diversion of foreign aid away from HIV/AIDS and toward other health priorities. While there is clearly a need to give urgent and additional resources to an array of global health priorities, not least maternal and child health, cutting HIV/AIDS funding is not the answer.

Reducing funding at this juncture would not only undermine the goal of reducing maternal and child mortality, but it could also lead to the interruption of treatment for people with HIV/AIDS already on ART, and leave those still in need of access to treatment to die premature, avoidable deaths.

HIV/AIDS is the leading cause of mortality among women of child-bearing age worldwide and responsible for more than 50% of mortality in five of the countries with the highest HIV prevalence. This killer disease is an ongoing emergency that requires dedicated resources at the national and international levels. A strengthened commitment to other global health priorities must happen – but it must happen in addition to, not instead of, a continued and increasing commitment to HIV/AIDS.

This sustained support is essential both for the four million people already on treatment and the estimated six million people who currently need treatment in low and middle-income countries and still do not have access to it. Such support will also help reduce the burden of a number of other health concerns.

CONCLUSION: ADDRESSING THE FUNDING CRISIS

Global health remains underfunded. MSF has repeatedly called for increased global support for a number of pressing health needs such as childhood and maternal malnutrition, vaccinations, tuberculosis, and neglected tropical diseases. However, such efforts should not come at the expense of HIV/AIDS funding and programming: this will undermine opportunities for synergies between HIV/AIDS and other, often linked, health needs.

Funding for HIV/AIDS treatment is not keeping up with need, and appears to be shrinking. Funding shortfalls punish the early success of the last decade of ART scale-up, and threaten to have a devastating impact on people living with HIV/AIDS as well as efforts to prevent new infections. As global health actors retreat from providing direct support for AIDS treatment, more demand is placed on the Global Fund, which is itself critically underfunded.

In order to expand and sustain HIV/AIDS care and treatment worldwide MSF recommends:

  • Sustained and increased funding for HIV/AIDS from the international donor community and national governments – and a continued commitment to universal access to AIDS care and treatment
  • Improved treatment in line with scientific evidence and recognised international standards of care
  • Measures to ensure that prices of drugs and diagnostics remain within reach of poor countries

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