War against HIV/AIDS may be lost

In the last week or so there have been a number of news reports outlining concerns that funding for the fight against HIV/AIDS may be slowing down. You can read one such article at the New York Times by clicking here.

The last decade has shown huge advances in treatment. The cost of life-saving drugs, ARVs, has dropped by a factor of 120; a one year course now costs about $100, though one should really consider the annual cost of the whole therapy including consultations, lab tests and drugs for other, opportunistic infections, which is estimated at about $500 per patient per annum.

Four million HIV-positive people are currently benefitting from antiretroviral therapy (ART). These individuals stand a good chance, if they remain on treatment, of a relatively long life. HIV/AIDS is no longer the death sentence that it once was.

However for every person on ART there is another, or maybe more, that needs the treatment and cannot get it. In Uganda, thanks largely to funding from the USA, there are now almost 200,000 people on ART, up from just 10,000 in the year 2000, but it is estimated that as many as 500,000 should be; and what’s perhaps more worrying, there are 100,000 new infections every year.

Photos from our HIV/AIDS programme in Namuwongo, Kampala.

Globally, 7,400 people are infected every day.

Across the globe 4m people are receiving ART. These people owe their thanks to the United States of America which gives the majority of the current $10 billion funding, through the Global Fund and US President’s Emergency Plan for AIDS Relief (PEPFAR).

However this $10b is simply not enough; current estimates show that the world needs $27b this year to fight the disease and stem its flow.

The current levels of funding may allow for 10 million on treatment by the end of 2014. But by then, at least 36 million will be infected and 17 million in dire need.

We’re not winning the fight today…

“You cannot mop the floor when the tap is still running on it,” said Dr. David Kihumuro Apuuli, director-general of the Uganda AIDS Commission.

and sadly it looks like it is about to get worse. The board of the Global Fund is considering cancelling its next round of funds and PEPFAR is planning to “flat-fund” over the next two years rather than meeting last year’s promise to expand access to treatment; who remembers the call for “Universal Access”?

New Infections vs Spending

Another growing trend is to move funding from HIV/AIDS towards Maternal and Child Health programmes. Now I’m a huge fan of MCH programmes and trying to start some of our own in Uganda, but surely this change in funding is short-sighted. HIV/AIDS is still a major cause of mortality and morbidity for women of child-bearing age and what’s the point of saving more young children if we simply leave them more vulnerable to HIV/AIDS in later life.

We need to take another look at this; please ask the US Government to maintain its current level of support and meet the pledges already made. In the meantime local government leaders need to get serious and find ways to meet the growing, unmet, demand for treatments from internal budget sources, including for example the looming oil bonanza.

About Kevin Duffy

Interim Management and Consulting - Global Healthcare Development. Kevin has over ten years of senior management experience in the delivery of healthcare services in Africa and South Asia. His current focus is on the strategic development of policy, guidance, and tools to help healthcare organisations achieve sustainable impact – balancing the need to become financially sustainable, with the mission of ensuring equitable access to affordable healthcare services.
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