National & Global HIV Funding Shortfalls: R1 billion Rand Short to Close Deadly Treatment Gaps in South Africa in 2009. 06/04/09

At the IV South Africa AIDS Conference, the AIDS Law Project, Médecins Sans Frontières (MSF), the Southern African HIV Clinicians Society, and Treatment Action Campaign (TAC) called upon governments to urgently address funding shortfalls for HIV/AIDS.

The organisations learned that new ARV guidelines that would have changed eligibility for treatment initiation this year from CD4 under 200 to CD4 under 350 -- an internationally-recognised best practice -- was rejected by the National Health Council due to financial concerns.

"We don’t ration for other illnesses. We vaccinate all children and treat everyone with diabetes that we can reach. Why is our response different for HIV/AIDS?" said Dr Francois Venter, President of Southern African HIV Clinicians Society. "Treating fewer people and delaying treatment can cause unnecessary suffering and death in people with HIV, and places an additional burden on the health system. The more people receive the AIDS treatment they need now, the fewer will need more complex care later, including treatment and hospitalisation for opportunistic infections."

Department of Health (DOH) officials admit that the budget allocation for ARVs through the current HIV/AIDS conditional grant to provinces is at least R1 billion short of the amount initially budgeted to treat 220,000 people this year. The National Strategic Plan (NSP) for HIV/AIDS 2007-201 sets the target of initiating 285,000 new people on ARVs in 2009.

"Unless we fill the funding gap, the freeze on providing ARVs to more people waiting for treatment, as we saw in the Free State province, will turn out to just be the tip of the iceberg," said Mark Heywood, Director of ALP.

The organisations warn that funding is not keeping pace with the targets set forth in the NSP, including achieving 80% ART coverage and other targets for comprehensive care and support, and prevention.

"According to government, the NSP will cost R48 billion over the five-year period, but the total HIV/AIDS allocation is only R11.4 billion over three years," said Nonkosi Khumalo, Chairperson of TAC. "With only 999 days until the end of 2011 and a R1 billion budget shortfall, we need urgent measures to close the deadly treatment and funding gaps. There is no recession in the number of deaths due to HIV/AIDS."

Efforts in South Africa and other countries to scale-up and sustain HIV/AIDS treatment are also threatened by inadequate international donor support. The Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), which distributes a quarter of international donor funding for HIV and 50% for TB, faces a US$4 billion deficit.

"We have seen first-hand the impact of increased international funds on health programmes, particularly for HIV/AIDS, TB, and malaria," said Dr Eric Goemaere, Medical Coordinator for MSF in South Africa. "In Khayelitsha, national and Global Fund financing makes it possible for over 10,000 people to be on life-saving HIV/AIDS treatment today. The leaders of the 20 largest economies in the world, who are meeting in London today to discuss how to address the economic crisis, must make good on their past promises. The Global Fund's deficit, which might be considered a 'rounding-up error' by wealthy countries will be a matter of life and death for people living in poor countries."

HIV/AIDS is responsible for an estimated 1,000 deaths each day in South Africa. There are more than 5 million people living with HIV/AIDS in the country. Currently an estimated 700,000 people have been initiated on ART, and a further 1.2 million people will need ART by 2011. For 2007, the coverage of ART for those with an AIDS-defining illness is only 34%. Currently, South Africa is initiating 200,000 people on ART per year. To reach the targets of the NSP, 420,000 people per year would need to be initiated on ART.

ALP and TAC point to the lack of transparency and accountability of budget decisions and the shifts of financial resources away from health, all of which are partly to blame for the poor state of South Africa's health system.

"We need to recognise the importance of health in this country and ensure that adequate finances are available to scale up access to healthcare in accordance with the Constitution," said Mr Heywood. "A major problem is that health budgeting is not needs-based. We are given a figure and then we determine how many people we can reach, instead of assessing how much it would cost to meet health and treatment needs. We call on government to provide budget allocations based on need and that all funds are spent effectively and efficiently to save as many lives of people waiting for treatment as possible."