ARV Funding Apocalypse is upon us. 29/11/11

Should the current trend of less money for HIV/Aids treatment programmes continue, all the progress seen in the last few years will be wiped away.

Daily Maverick
By Sipho Hlongwane

29 November 2011

Medecins sans Frontieres doesn’t mince its words. Should the current trend of less money for HIV/Aids treatment programmes continue, all the progress seen in the last few years will be wiped away.

MSF warned it’ll be back to the dark days of the late 1990s and earlier in this millennium. The problem, obviously, is that the massive global recession (and mismanagement of funds by recipient countries) have led to donor fatigue in rich countries – and the victims are the poor countries in sub-Saharan Africa.

It isn’t often that a single announcement manages to shake an entire region. But the one issued last week by the board of The Global Fund to Fight Aids, Tuberculosis and Malaria that it would have to cancel the 11th round of funding, certainly did. This means we could see the majority of the money used to fund antiretroviral and tuberculosis programmes in sub-Saharan Africa disappear after 2012.

The reason for the funding cut has a lot to do with how the fund is structured – most of the money comes from governments in western Europe. Faced with a crippling recession (with the prospects of another growing by the day) at home, the choice has been to cut back largesse abroad. The US is faced with similar pressure.

The other reason is Africa’s perennial old bugbear: mismanagement. Germany and Sweden have frozen $20 million in funding pending an audit into alleged mismanagement of funds in Djibouti, Mali, Mauritania and Zambia.

The global recession couldn’t have come at a worse time for HIV sufferers. Médecins Sans Frontierès has been one of the first organisations in the world to do the Paul Revere ride to warn of the trouble in which we could find ourselves. Joined by the Treatment Action Campaign and Section 27 at a press conference on Monday, they spelt out the size of the peril.

The Global Fund alone pays for more than 70% of ARV drugs in the developing world and 85% of TB programming in Africa. Governments in sub-Saharan Africa have set up entire systems of ARV and TB drug distribution based on this programme’s financing.

The way Round 11 of funding has been cut back is that all programmes, save for those designated as “emergency”, will not receive any new funding. No new people will be put on ARV therapy.

The problem doesn’t seem that dire until you see some of the statistics MSF provided: only 63% of people who need ARV treatment in Zimbabwe receive it. In Swaziland (where 26% of the adult population is believed to be living with HIV/Aids), about 76% of people who need ARVs receive them. The pattern is similar in all the SADC countries. In South Africa, about half the people who need ARVs can get them.

Eric Goemaere of the MSF’s South Africa Medical Unit, said the main reason these programmes succeeded in pushing back the rate of death and infection is that they were constantly being scaled up. It isn’t just enough to be treating a certain number of people every year – that number has to constantly increase to keep the spread in check.

The worst consequence is people will no longer have faith in these programmes to treat HIV/Aids, and they’ll simply stop applying or turning up at clinics for treatment. Goemaere said, “The waiting list for ARV programmes will increase. We might have to go back to rationing the medication, or selecting the patients who receive treatment. The mortality rate will increase and people will begin to say that the programme doesn’t work and will stop using it.”

He pointed out that when the fund was established in 2001, the world misguidedly thought a cure for Aids would be a reality by 2011. That projection is now now another decade away.

“The message [from donors] to those countries is: be extremely careful because we will not be able to fund you forever,” Goemaere said.

The challenge for those countries now is to somehow scale up the treatment programme even as future funding guarantees fall away. The representatives from the MSF, Section 27 and the Treatment Action Campaign all called on South Africa to “show leadership” on the issue by lobbying donor countries not to cut back on funding.

Daygan Eager of Section 27 said South Africa’s moral position puts it in a special position to lobby on behalf of its neighbours. “If South Africa is silent, it will be very difficult for neighbouring countries to lobby donor countries,” he said.

Can South Africa champion cause? If it wants to dodge the bullet of sub-continental catastrophe, it had better finds ways to do so. DM