Simon Collins, HIV i-Base
Some of the first indications that the economic debt crisis in Europe will contribute to 2012 being a disastrous year for global health came in articles from the corporate financial institution Bloomberg Businessweek (not known for it’s focus on HIV news) and the mainstream scientific journal Nature.
This year will not be business as usual for anyone, and those most dependent on international aid are most vulnerable.
The impact of the suspension of Round 11 of Global Fund grants, reported in both this and the previous issue of HTB is causing global concern. The Bloomberg article includes MSF data on 28,000 people in the Democratic Republic of the Congo who will not now be able to start treatment. This seems likely to be an underestimate. Similar reports and concerns – often with a greater human impact – are likely to apply to every country with limited access to HIV treatment.
For example, in a report on the implications of the funding crisis for Malawi, which currently has no funding past 2013, an estimated 200,000 people currently in need of treatment will not be able to access antiretrovirals.
Both reports focus on the impact that unfulfilled pledges from 2008 from leading European countries has had on the Global Fund. According to the Fund’s website, outstanding pledges include $168 million from Italy (from 2009) and $116 million from Spain (from 2010). Five countries – Italy, Spain, Greece, Iceland and Portugal – also made no pledges last year. Holland has cut the proportion of GDP allocated to development assistance from 0.8 to 0.7%. While the US increased funding by 1.6% to $7.6 billion and the UK and Germany (the second and third largest donors after the US) increased pledges by 14%, global donor commitments that had increased to $8.7 billion in 2008, flat-lined in 2009 and dropped by 10% in 2010. The budget available for treatment in the PEPFAR fell by 17% and was accompanied by a shift from adult care exclusively to a mother and child programme. In countries where funding programmes has made treatment is available – and over six million people now access ARVs – it remains largely based on archaic use of d4T (stavudine) despite alternatives such at tenofovir being cost effective. The funding uncertainty will clearly also undermine key WHO recommendations to switch away from use of d4T and earlier treatment using a CD4 threshold of 350 rather than 200 cells/mm3.
Access to treatment has always provided the incentive for people to come forward to test. Whether this was for AZT in 1987 or HAART in 1997 in Western countries or in any of the global access programmes rolled out since 2000. Without the hope of any intervention to improve a person’s individual health it has always been difficult to argue that learning you are HIV positive is going to improve your quality of life. Even with treatment, diagnosis is currently late for the majority of people, when defined as a CD4 count lower than the threshold recommended for starting treatment. But without it, HIV will be driven back underground, testing programmes will falter, and the progress from the last ten years will slowly be lost.
It is spectacularly short sighted for this to be occurring at exactly the time when effective treatment is not only cheaper than every before but also proven to be the most effective method of preventing further transmission.
Bennett S. Financial crisis may kill in Congo as global health aid stalls. Bloomberg Buisnessweek. 17 January 2012
MSF press statement: DRC: Majority of people living with HIV denied treatment. (25 January 2012).
Farquhar D et al. Breaking promises to the poor: the donor retreat puts Malawi’s AIDS programme in peril (unpub).
Wadman M. Cutbacks threaten HIV gains. Nature; 480; 159-160. (08 December 2011).