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HIV/AIDS: Donors gambling with patients’ lives by retreating from funding

Vienna
Published 19 July 2010

 

International donors are disregarding scientific evidence on the benefits of earlier and expanded treatment to achieve short-term cost savings at the expense of the 10 million people in need of treatment. This today from emergency medical humanitarian organization Médecins Sans Frontières (MSF) at the International AIDS Conference taking place this week in Vienna.  

“Today international donors expect doctors to tell patients to come back for treatment when they’re at death’s door,” said Dr. Eric Goemaere, medical coordinator with MSF in South Africa. “This is bad medicine. As a doctor I’d much rather give a patient pills today and send her home, than delay treatment and see her in six months at the hospital with complicated tuberculosis.”   

With data from its project in the southern African country of Lesotho, MSF will present “late-breaker” evidence at the AIDS conference this Thursday that shows how earlier treatment reduced the mortality rate and hospitalization among HIV patients by more than 60 per cent.

Morija, Lesotho 2010 © Zethu Mlobeli/MSF
MSF nurse Patricia Nyoni examines baby Relebohile, who is co-infected with HIV and TB. Both Relebohile and his mother, Majakobo Mkubu get their treatment at St Barnabas clinic, one of 14 rural clinics at the time supported by MSF in Lesotho and now managed by local health authorities. Majakobo and Relebohile need to make an arduous six hour mountain trek five times a month to reach the clinic.

But this type of research is being ignored by international donors, particularly the United States – the world’s primary HIV treatment donor – which is now advising countries to restrict treatment to those in the more advanced stages of HIV disease.

In addition to medical and financial benefits of earlier treatment initiation, studies are also showing that making treatment widely available at the community level is one of the most effective ways to prevent people from getting HIV.

Despite this evidence, there is a general trend toward backtracking on HIV funding which will increasingly mean treatment being delayed, deferred or denied. The Global Fund –the world’s principal funding mechanism for HIV treatment – faces a major financing gap. PEPFAR is the U.S. President’s Emergency Plan for AIDS Relief. The U.S. is proposing both continued PEPFAR program flat-funding and a decrease in its contribution to the Global Fund. Just this week, the German media reported top-level discussions to cut its contribution to the fund three-fold. Austria, the International AIDS Conference host country, has not contributed a single dollar to the fund since 2001.

This retreat comes after a decade of progress – more than 5.2 million people alive on treatment today – made possible by the emergence of affordable generic drugs and the commitment of donor countries. With 1.2 million people starting treatment in 2009, progress has been rapid. Yet there are still 10 million people waiting to start treatment and the current climate suggests a decreased commitment to fund treatment for those waiting in line.

“Donors repeatedly promised millions of people a lifeline to treatment,” said Goemaere. “It is a matter of choice: will donors help pay for treatment or let people die?”

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