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 by Médecins Sans Frontières (MSF). The MSF report highlights how expanding access to HIV treatment has not only saved the lives of people 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 very significant decreases in overall mortality in areas where antiretroviral therapy coverage was high. Increased treatment coverage has also had an impact on the burden of other diseases. Tuberculosis cases, for example, 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. But 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,” says Tido von Schoen-Angerer, a medical doctor and director of MSF’s Access to Essential Medicines Campaign. International support to combat HIV/AIDS is faltering as reflected in significant funding shortfalls. The board of directors of the Global Fund, a key financer of AIDS programs in poor countries is unable to respond to countries’ needs and will next week in Addis Ababa vote whether or not to suspend all new funding proposals in 2010; and PEPFAR, the U.S. AIDS program is flat lining funding for two more years. “The Global Fund must not cover up the deficit caused by its funders,” says 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.” 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? 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,” says Olesi Ellemani Pasulani, MSF clinical officer in Thyolo District Hospital, Malawi. “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 that have now been 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, particularly in high HIV-prevalence settings, treating AIDS 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,” adds 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 around 30 countries and provides antiretroviral treatment to more than 140,000 HIV-positive adults and children. The new MSF report: Punishing Success? Early Signs of an International Retreat from Commitment to HIV/AIDS Care and Treatment, is available at www.msfaccess.org .