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Backtracking on International Funding for HIV/AIDS Treatment: Consequences in Several African Countries

Author(s): M. Philips*1, S. Lynch1, R. Leray1, S. Rens1, E. Maclean2
Affiliation(s): 1Analysis and Advocacy Unit, Medecins sans frontieres, BRUSSELS, Belgium, 2Advocacy liason officer, Medecins sans frontieres, New York, United States
Keywords: HIV/AIDS, donor policies, economic crisis, scale up, treatment continuity
Background:

The significant increase in funding for HIV/AIDS prevention, treatment and care of the last years has contributed to effectuive scale up of treatment efforts for HIv infected people and in particular those in urgent need of ARV. Recently public opinion has tried to shed doubts over the necessity to continue funding for HIV/AIDS and suggest the funding should shift to other health problems and in particular health systems support. Both at international and at country level this has been followed by significant reduction of funding for HIv treatment and in particular continued supply of essential commodities. This has come at a time where the effects ogf the financial and economic crisis start to hit developing countries.

Methods:

An analysis was made of the current and intended funding streams and volumes for HIV treatment in several countries: South Africa, Lesotho, Mozambique, Malawi, Kenya, Zimbabwe and DRC. Additionally interviews of key informants among health authorities and the major funding agencies were held.

Results/Conclusions:

The first consequences of the funding withdrawal are being reported from various countries: capping or halting enrollment of new patients on ARV seems the earliest measure taken. Further scale up is put into question and ambitions at country level are dampened in terms of objectives set and timeline to achieve them.
International donors tend to transfer the responsability for previously funded commodities to the government and implementing agencies faced with cutbacks refer patients to public services for treatment initiation previously.
Most agencies look towards the government or the Global Fund for AIDS, Tuberculosis and malaria (GFATM) to fill the funding gap. However, with domestic revenues constrained and the GFATm itself facing a shortfall in funding, this strategy is sacrificing other important interventions in HIV/AIDS prevention, treatment and care. Thus the GFATM will be unable to continue to reach the intended performance. Moreover certain countries are facing interruption or disruption of funding and supplies through the GFATM.
The reduction of the funding enveloppe and of the current funding channels makes continued scale up and sustained treatment extremely vulnerable.
This backtracking on previous commitments to universal access and scale up of HIV prevention, treatment and care is in sharp contrast with the first important benefits of increased efforts in HIv and health, wider than the lives saved of those under treatment, but also with signs of positively impacting on mortality and incidence rates. Reducing HIv funding, still insufficient in terms of the needs, will jeopardize current successes and put thousands of people at risk.
Without effective evidence of increased funding for other health interventions, one can question the likelihood of predictable and sustained funding following the public discourse that other health priorities should now benefit.

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