Punishing success in tackling AIDS: funders retreat could wipe out health gains in HIV affected countries

MSF press release

A retreat from international funding commitments for AIDS threatens to undermine the dramatic gains made in reducing AIDS-related illness and death in recent years, according to a new report by M裥cins Sans Fronti籥s (MSF).

The report expresses concern that the international community is backing off of commitments to support universal access targets and point to a number of troubling signs including:

  • The funding problems of the Global Fund to Fight AIDS, TB, and Malaria (GFATM). The funding shortfalls led to substantial cuts in Round 8 approved proposals (10% in Phase 1, and 25% in Phase 2) and may lead to additional cuts on Round 9 approved proposals. Also, we are very concerned that the Board of Directors of the GFATM may approve a resolution being tabled to delay Round 10 until 2011, again because of lack of funds.
  • The flatlining of the US government’s budget for PEPFAR in 2010 and 2011 and caps on new patients on ART, as well as anxiety and mixed messages leading to capping enrollment in Uganda.
  • The changes in the donor landscape including Netherlands, the third largest donor through bilateral channels, is cutting its aid by 30%, and the UK which had led the campaign to support universal access to treatment at the G8 Summit 2005 providing less money to support scale-up.
  • The dangerous trends in the global policy arena where detractors of AIDS funding are calling for a diversion of HIV/ AIDS funds for other health issues, rather than building upon the success of the mobilisation of resources for AIDS by insisting that global health, of which HIV is a part, be adequately supported.

It also points to the progress of the last years, especially in South Africa and Malawi, of scaling-up ART and the resulting impact in reducing mortality and morbidity and warn that unless sustained and increased funding for HIV/AIDS is provided – by national governments as well as donors – we risk punishing the success of the last years.

The MSF report highlights how expanding access to HIV treatment has not only saved the lives of people with AIDS but has been central to reducing overall mortality in a number of high HIV burden countries in southern Africa in recent years. In Malawi and South Africa, MSF observed very significant decreases in overall mortality in areas where antiretroviral therapy (ART) coverage was high. Increased treatment coverage has also had an impact on the burden of other diseases, for example tuberculosis cases have been significantly reduced in Thyolo, Malawi and Western Cape province, South Africa.

International support to combat HIV/AIDS is faltering as reflected in significant funding shortfalls. The board of directors of the Global Fund, a key financer of AIDS programmes in poor countries is unable to respond to countries’ needs and will next week in Addis Ababa vote whether or not to suspend all new funding proposals in 2010; and PEPFAR, the US AIDS programme is flatlining funding for two more years.

The report provides evidence that, particularly in high HIVprevalence settings, treating AIDS has a positive impact on other important health goals, in particular maternal and child health.

At present, over four million people living with HIV/AIDS in the developing world receive antiretroviral therapy. An estimated six million people who are in need of life-saving treatment, are still waiting for access. MSF operates HIV/AIDS programmes in around 30 countries and provides antiretroviral treatment to more than 140,000 HIV-positive adults and children.


MSF Press release: “Punishing success in tackling AIDS: Funders’ retreat could wipe out health gains in HIV affected countries”. (5 November 2009).

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