Donor fatigue is slashing access to AIDS care in Africa, warns charity

Growing donor fatigue towards funding HIV/AIDS risks undermining years of positive achievements and will cause many more unnecessary deaths, says a report by the charity Médecins Sans Frontières.

On the basis of detailed analyses made in eight sub-Saharan countries, the report illustrates how major international funding institutions such as the US president’s emergency plan for AIDS relief, 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 over the past 18 months.

The charity says the findings “confirm our concerns in terms of donor backtracking on commitments to scale up the fight against the HIV/AIDS epidemic. Today, this disengagement is starting to become visible in the field and the level of HIV care is beginning to deteriorate.”

The report says effective HIV/AIDS interventions “have numerous cross benefits and spin offs on the broader health sector” and that achieving the Millennium Development Goals cannot be tackled without addressing HIV/AIDS. Yet a lack of sustained donor commitment “is jeopardising worldwide efforts to fight this deadly disease.”

Overall funding cuts “have translated into a reduction in the number of people able to start their ARV [antiretroviral] treatment.” In Congo the number of new patients able to start treatment has been cut sixfold.

Mit Philips, the charity’s health policy analyst, told the BMJ that donors are shifting attention from AIDS funding towards health system strengthening but “this policy is not coherent” as already fragile health systems “will become increasingly strained by an increasing patient load requiring more intensive care.”

The report says that drug stock outs and disruptions in drug supply “are already a reality, and will become more frequent if sufficient funding is not made available.”

It points out that antiretroviral 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.

Reduced funding not only hampers HIV treatment scale-up but also “threatens to undermine” all the positive effects that high coverage of antiretroviral treatment brings in terms of “community-wide reduction of mortality, morbidity and transmission.”

Any retreat from the current efforts towards antiretroviral treatment scale-up “will have far reaching and very real negative consequences” for patients and front line workers in HIV care.

Dr Philips says that donors are being “penny wise and pound foolish” because delays in starting antiretroviral treatment in line with the World Health Organization’s guidelines will eventually result in increased long term health costs.

She warned that this “head in the sand response” means that the AIDS crisis will return with a vengeance.

She said, “How 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.”