Donor Fatigue New Threat to HIV, AIDS Fight. 20/8/10
Waning interest among donors has diminished hope for the more than 22 million people living with HIV/AIDS
By Nelson Chenga
20 August 2010
Harare — AN aftershock of the deadly HIV and Aids tremor whose epicentre was located in sub Saharan Africa way back in the 1990s threatens to reverse all the gains made so far in the fight against the world's most dreaded ailment. The shock is in the form of alarming donor fatigue that is being felt across the sub-region.
The waning interest among donors has diminished hope for the more than 22 million people living with HIV and Aids who were now pinning all their expectations on Anti Retro-viral drugs (ARVs) that have altered the fearsome face of the devastating endemic.
Medecins Sans Fron-tieres (MSF) -- an international humanitarian organisation -- and Do-ctors Without Borders have both raised the red flag, shouting: "No time to quit. The HIV crisis is far from over."
MSF is piling up pressure on its partners in the donor community not to quit Africa where the Human Immuno Virus (HIV) and the Anti Immuno Deficiency Sy-ndrome are widespread, reminding them why they started the fight against HIV in the first place.
"This donor turn-around will not make the patients in need of life-saving treatment go away... Progress and scale up are still direly needed. Our responsibility towards people living with HIV and Aids in the hardest-hit countries has been collective in the past decade and it should remain so for years to come," says MSF, which started operations in Zim-babwe in 2000.
The organisation is extending medical care to 52 000 HIV patients of which 39 000 are receiving life-saving Anti Retroviral Treat-ment (ART) while 44 322 have been on treatment since the programme commenced.
Of major concern to MSF is that the key donor, the United States President's Plan for Aids Relief has flattened funding; the World Bank is not funding ARVs but investing in health systems and capacity building; the international facility for the purchase of drugs, UNITAID, is phasing out funding; and the Global Fund has a severe funding shortfall.
These developments come at a time when a lot is still at stake.
Of the nine million people in desperate need of ART only four million are on ART at a time when 1,4 million are dying each year due to HIV and Aids-related illnesses.
Martha Tholanah, one of the many people living with HIV in Zimbabwe said: "We are already feeling the effects of the donor fatigue here. When I went for a CD4 count at Parirenyatwa in July I was told the institution was fully booked until December this year. They told me to go to private facilities where I had to pay US$49 and how many people living with HIV and Aids out there can afford that?"
Periodic CD4 counts, which determine how strong one's immune system is and which is established by finding out the number of T-cells remaining in the body to fight infection, is essential in helping doctors during ART.
For example, when Tholanah tested HIV positive in 2003 her CD4 count was 31 but the amount of T-cells have since risen to 970 today following treatment.
Recently, the World Health Organisation (WHO) revised the recommended CD4 count for people to be put on ART from 200 to 350, which means that there are now more people requiring ART than before at a time when donors are losing interest in HIV programmes.
WHO's idea of increasing the threshold was based on the observation that if treatment is started early deaths or illnesses are reduced significantly.
However, news that international donors are capping or reducing HIV support is particularly devastating for Tholanah, whose tale offers an intriguing insight into the HIV condition.
When she tested positive Tholanah was pregnant at the time. Her husband demanded that she should abort but she refused and he left her after which she suffered psychological persecution, stigma and discrimination from society including her own church.
She however, gave birth to an HIV negative daughter who is now in Grade 2.
"People are already dying while on the waiting list to go on ART. It's going to be even worse unless the government chips in," said Tho-lanah.
Out of the over 590 000 people requiring treatment in Zimbabwe there are only 260 000 on ARVs and if funding shrinks any further the country's goal to meet the United Nations' Millennium Development Goal number six -- combating HIV and Aids, malaria, and other diseases by 2015 -- will go off course.
The Zimbabwe government introduced a three percent AIDS levy at the height of the virus in the 1990s but an economic meltdown in the first decade of the 21st Century rendered the effort useless, which meant that the country had to heavily depend on donor assistance.
While the Aids levy was also mired in controversy, it is the backing Zimbabwe got from the international community that helped reduce the country's HIV prevalence rate from around 26 percent to the current 13,6 percent.
At the height of the disease one in six people were said to be living with HIV and today one in three are believed to be living with the disease.
But despite the decline in the HIV prevalence rate the burden of HIV and Aids remains very high.