Punishing Success in Tackling AIDS

A retreat from international funding commitments for AIDS threatens
to undermine the dramatic gains made in reducing AIDS-related illness
and death in recent years, according to a new report released today by
the international medical humanitarian organization Doctors Without
Borders/Medecins Sans Frontieres (MSF).

International support to combat HIV/AIDS is faltering, as reflected
in significant shortfalls among two of the world's main funding
mechanisms for HIV/AIDS. The board of directors of the Global Fund, a
key financer of AIDS programs in poor countries, is unable to respond
to countries' needs. The board will vote next week in Addis Ababa
whether or not to suspend all new funding proposals in 2010. The US
President's Emergency Plan for Aids Relief (PEPFAR), the American
government's AIDS program, is capping funding for two more years. This
means that new patients will be turned away for treatment.

Report: Punishing Success: Early Signs of a Retreat from Commitment to HIV Care and Treatment.

The MSF report highlights how expanding access to HIV treatment has
not only saved the lives of people living with AIDS but has been
central to reducing overall mortality in a number of high HIV burden
countries in southern Africa in recent years.

In Malawi and South Africa, MSF observed significant decreases in
overall mortality in areas with high antiretroviral therapy (ART)
coverage. Increased treatment coverage has also had an impact on the
burden of other diseases. For example, tuberculosis cases have been
significantly reduced in Thyolo, Malawi and Western Cape Province,
South Africa.

"After almost a decade of progress in rolling out AIDS treatment we
have seen substantial improvements, both for patients and public
health," said Dr. Tido von Schoen-Angerer, director of MSF's Access to
Essential Medicines Campaign. "Recent funding cuts mean doctors and
nurses are being forced to turn HIV patients away from clinics, as if
we were back in the 1990s before treatment was available."

"The Global Fund must not cover up the deficit caused by its funders,"
said von Schoen-Angerer. "The proposed cancellation of the 2010 funding
round and other measures to slow the pace of treatment scale-up are
punishing the successes of the past years and preventing countries from
saving more lives."

PEPFAR has had a huge impact on increasing the number of people on
AIDS care and treatment in poor countries since 2003, supporting more
than two million people on treatment with a commitment to increase
treatment to at least three million by 2013. But U.S. government
HIV/AIDS funding has remained the same for 2009 and 2010 and early
signs indicate there will be no increase in funds for 2011 either. The
proportion of PEPFAR's budged dedicated to treatment has actually
decreased. Only a handful of countries will be able to increase the
number of new patients at a pace similar to what PEPFAR has supported
in the past.

In 2005, world leaders promised to support universal AIDS coverage
by 2010, a promise that encouraged many African governments to launch
ambitious treatment programs.

"What about the promise made to people with AIDS?" said Olesi
Ellemani Pasulani, MSF clinical officer in Thyolo District Hospital in
Malawi. "We gave them hope and life. We have to be there for them. We
all knew from the beginning that this treatment was for life. Passing
on the bill for treating AIDS to very poor countries would be a
colossal betrayal."

Reducing funding at this time will leave people in urgent need of
treatment to die prematurely, and can lead to dangerous interruption of
treatment.

In Uganda, cuts have already begun to hit home, with some facilities
forced to stop treating new patients with HIV. Other countries are
backing away from their earlier treatment coverage targets. In Free
State, South Africa, past funding problems-since resolved-led to
disruption of treatment and a moratorium on treating new patients,
which resulted in an estimated 3,000 deaths.

The report provides evidence that treating AIDS, particularly in
high prevalence settings, has a positive impact on other important
health goals, in particular maternal and child health.

"A stronger commitment to other health priorities must happen, but
this should be in addition to, not instead of, continued, increased
commitment to HIV/AIDS," said von Schoen-Angerer.

At present, over four million people living with HIV/AIDS in the
developing world receive antiretroviral therapy. An estimated six
million people who are in need of life-saving treatment are still
waiting for access. MSF operates HIV/AIDS programs in approximately 30
countries and provides antiretroviral treatment to more than 140,000
HIV-positive adults and children.