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Africa: World Backtracks on HIV Treatment
AfricaFocus Bulletin
May 21, 2010 (100521)
(Reposted from sources cited below)
Editor's Note
"Around the world thousands of doctors, nurses, legislators, and
activists helped make treatment scale-up possible. Now a few power
brokers and politicians who claim AIDS receives too much money seem
intent on bringing to an end this remarkable effort, in effect
saying to millions of people: drop dead. Without treatment, this is
certainly their fate." - Gregg Gonsalves, International Treatment
Preparedness Coalition
Uganda's Peter Mugenyi, who testified before the U.S. Congress
earlier this year about the devastating effect of cutbacks in U.S.
AIDS funding commitments on patients in Uganda
(http://www.africafocus.org/docs10/hiv1003.php), provides the
foreword for the latest report from the International Treatment
Preparedness Coalition, which documents early warning signs of
declining international and national commitment to universal access
to treatment for AIDS, in Kenya, Malawi, and Swaziland as well as
3 non-African countries (India, Latvia, and Venezuela).
The report is the latest documentation of the threat of "AIDS
fatigue," which is allowing governments in rich countries to
backtrack on commitments to the Global Fund to Fight AIDS, TB, and
Malaria and to the U.S. bilateral PEPFAR Program. Despite renewed
efforts to call attention to the danger, and new commitments in key
countries such as South Africa, the odds of providing universal
access by the end of this year have reached the vanishing point.
Today some 4 million people of the approximately 10 million who
need AIDS treatment worldwide are receiving it, a dramatic advance
from a decade again when most assumed that treatment for those in
poor countries was impossible. But at least 6 million are not being
treated (and under new WHO treatment guidelines the number needing treatment
may increase by as much as 4 million more). The danger is that the global effort will
falter rather than building on its successes.
This AfricaFocus Bulletin, available on the web, but not sent out
by e-mail, contains a press release and substantive excerpts from
the ITPC report. The full ITPC report is available on
http://www.itpcglobal.org
Another AfricaFocus Bulletin sent out today has recent statements
by AIDS activists calling for governments to meet their
commitments. Demonstrations earlier this month included one in New
York targeting a speech by U.S. President Barack Obama, and one in
Dar es Salaam targeting the meeting of the World Economic Forum.
For previous AfricaFocus Bulletins on health issues, visit
http://www.africafocus.org/healthexp.php
++++++++++++++++++++++end editor's note+++++++++++++++++++++++
Evidence from Six Countries Confirms Fears of People Living With
HIV/AIDS: Treatment Rationing Is Escalating
New report documents early warning signs of devastating impact to
come from flatlining and cutting AIDS funding
International Treatment Preparedness Coalition
26 April 2010
Contact:
Kay Marshall, New York, +1 347-249-6375, [email protected]
Aditi Sharma, Delhi, +91 991 0046 560, [email protected]
DELHI & KAMPALA - Rationing Funds, Risking Lives: World Backtracks
on HIV Treatment, the new report from the International Treatment
Preparedness Coalition (ITPC), documents early warning signs
resulting from the global pullback on AIDS commitment and funding:
caps on the number of people enrolled in treatment programs, more
frequent drug stock outs, and national AIDS budgets falling short.
"AIDS is not over. ITPC's report clearly shows that the response is
being starved, not overfunded. Governments, North and South, cannot
afford to put the clock back and return us to the days when HIV was
a death sentence," said Aditi Sharma of ITPC, coordinator of the
report. The effect of government budget cuts and flatlined funding
from major donors like U.S.' PEPFAR (President's Emergency Plan for
AIDS Relief) and the Global Fund to Fight AIDS, Tuberculosis and
Malaria are already being felt in the developing world. The Fund
would need $20 billion over the next three years to help meet the
health-related Millennium Development Goals (MDGs), but G8 nations
and other donors are warning that raising even $13 billion (the
lowest target which will mean a dramatic slow-down in pace of
delivery) is a "huge stretch."
"In my home country, Uganda, for the first time since 2004, some
HIV-positive men and women who are in need of life-saving
antiretroviral treatment are being turned away because of funding
cuts. Our greatest fear is that we may have to ration HIV
medications for those already receiving treatment. How do you tell
an HIV-positive mother that she can no longer have the drugs she
needs to stay alive? ITPC's report makes it painfully clear that
Uganda is not alone in facing an escalating treatment crisis," said
Peter Mugyenyi of the Joint Clinical Research Centre in Uganda and
author of the foreword.
As evidence mounts that AIDS treatment is inexorably linked with
other health issues, including maternal health and tuberculosis,
ITPC argues that it will not be possible to build sustainable,
credible health systems as the waiting lines for AIDS drugs grow.
"Providing access to AIDS treatment for four million people has
been the most ambitious public health effort in history," said
ITPC's Gregg Gonsalves. "Around the world thousands of doctors,
nurses, legislators, and activists helped make treatment scale-up
possible. Now a few power brokers and politicians who claim AIDS
receives too much money seem intent on bringing to an end this
remarkable effort, in effect saying to millions of people: drop
dead. Without treatment, this is certainly their fate."
Rationing Funds, Risking Lives documents numerous gains in
providing access to HIV treatment in six countries. However, people
living with HIV often struggle to afford medicines for
opportunistic infections, transport costs, food, and second-line
medications and continue to face stigma and discrimination.
Programs to prevent vertical transmission of HIV run contrary to
WHO guidelines in several countries and fail to reach most women.
International Treatment Preparedness Coalition
In several countries, the financial sustainability of AIDS
treatment programs is in question, effectively ending any hope of
achieving universal access to HIV treatment or the MDGs. India:
access to second-line antiretrovirals (ARVs) is severely limited
because of strict eligibility criteria for the government program
and high cost in the private sector. "As an emerging economy, India
is facing dwindling support from donors," said Vikas Ahuja, of
Delhi Network of Positive People (DNP+). "At the same time, we need
to meet growing need, expand treatment access for most at risk
populations and increase access to second-line ARVs and prevention
of vertical transmission services. The government must urgently
develop and implement sustainable plans to keep people alive."
Kenya: donor cutbacks and a lack of adequate domestic funds will
cause the financing gap for treatment to further widen this year.
"The outlook in Kenya is bleak. In the last few years, we've made
progress on expanding access to treatment, but 90 percent of AIDS
treatment funding comes from external sources," said Rosemary
Mburu, of the Kenya AIDS NGO Consortium (KANCO). "We are now facing
cutbacks from some donors, which will devastate our already
over-burdened treatment programs. The government must step up and
find ways to fill the financing gap."
Latvia: the government is imposing limits on the number of patients
provided with free ARVs as HIV treatment costs are shockingly high
compared to most other middle-income countries. "Latvia has been
hard hit by the economic downturn and AIDS treatment programs are
likely to be one of the causalities of government cutbacks," said
Inga Paparde of Apvieniba HIV.LV. "HIV rates here are among the
highest in the European Union, so this is no time to cap treatment
programs and limit access. The government needs to move quickly to
bring the price of HIV drugs down, including by using generic
medicines."
Malawi: the health care system is further weakened by a severe
shortage of qualified doctors and nurses. "In Malawi, some health
facilities only distribute ARVs once or twice a week, to allow
overworked healthcare workers to also focus on other health
concerns," said Martha Kwataine of the Malawi Health Equity Network
(MHEN). "We face a severe shortage of doctors and nurses, and we
cannot adequately scale up HIV treatment or other health programs
until this crisis is addressed."
Swaziland: tuberculosis is the leading killer of people living with
HIV, yet effective integration of TB and HIV treatment is lacking.
"Here in Swaziland, TB is the major cause of death for Swazis
living with HIV, said Tengetile Hlophe of Swaziland for Positive
Living (SWAPOL). "Far too many people are living with both
diseases, but may only be receiving treatment for one. Many of
those lives could be saved if TB and HIV treatment programs are
better integrated."
Venezuela: the government is working from an outdated national AIDS
plan and lacks reliable data on the number of people living with
HIV or those in need of treatment. "We don't know how many people
in Venezuela are living with HIV and how many need treatment--the
government has no reliable figures," said Renate Koch of Acci�n
Ciudadana Contra el Sida (ACCSI). "The government must take
responsibility for improving epidemiological data and must work
with civil society to develop a National Strategic Plan in order to
increase awareness, testing, and treatment of HIV."
The report, the 8th in the Missing the Target series, is published
by International Treatment Preparedness Coalition (ITPC). The full
report is available at www.itpcglobal.org. /ENDS
Missing the Target
Rationing Funds, Risking Lives: World backtracks on HIV treatment
On-the-ground research in India, Kenya, Latvia, Malawi, Swaziland,
and Venezuela
April 2010
International Treatment Preparedness Coalition
http://www.itpcglobal.org
contact information Aditi Sharma: [email protected]
Sarah Zaidi: [email protected]
Gregg Gonsalves: [email protected]
Foreword
In March 2010, I was invited to give testimony before the U.S.
Congress by the House Subcommittee on Africa and Global Health.
The focus of the gathering, at which I was joined by other health
and HIV advocates from around the world, was the Obama
administration's budget request for the 2011 fiscal year for the
landmark U.S. President's Emergency Plan for AIDS Relief
(PEPFAR). The proposed budget would increase funding for PEPFAR
by 2.2 percent.
First and foremost, I would like to express our thanks and great
appreciation to the American people for PEPFAR. More than three
million people are now getting lifesaving antiretroviral
treatment (ART) in resource- constrained countries, most of them
in Africa. These people-- and their mothers, husbands, wives and
children--got a chance to live. This is a chance they simply
would not have without these drugs.
However, the AIDS crisis is not over. On the contrary it has
gotten worse because it was left to get far out of hand before any
serious international intervention took place. The logical
response following the start of PEPFAR (in 2003) and the launch
of the Global Fund (in 2002) was a long-term commitment to match
funding support with the inevitable rise in demand, while
building up the capacity of the hard-hit countries until the back
of the epidemic is broken. That commitment was made, most
noticeably at the summit of G8 leaders in Gleneagles, Scotland in
2005. Within three years, however, most countries had abandoned
it.
Yet even in light of the fact that about 60 percent of people in
urgent need of lifesaving ART are still not accessing it, some
would say, and have said, that even matching last year's level,
let alone an increase, is remarkably generous given the current
economic and political climate in the United States and much of
the world. I don't agree. Along with other major donor nations,
the United States made a commitment at Gleneagles to
significantly ramp up funding and support for pressing global
development concerns, including HIV/AIDS. It is not alone in
having failed to honour that pledge in recent years, and a paltry
increase of 2.2 percent for PEPFAR will do nothing to get it back
on track. The gravity of the situation being as it is, there is
nothing generous about this development or trend.
Donor governments' inability or unwillingness to meet their
commitments is one of the main reasons the ambitious--but
certainly never irrationally unobtainable--goal of achieving
universal access to HIV treatment by the end of 2010 will not be
met. The consequences are dire both for the millions who have
been able to access lifesaving treatment in recent years and the
millions more in need.
In my home country, Uganda, lower-than-anticipated funding
support from PEPFAR and other donor entities in the past couple
of years has forced many facilities to turn away new HIV-positive
patients seeking ART. Individuals already on treatment and their
health care providers are worried that insufficient funding could
force a rationing of care that would lead to some patients having
their ART access revoked entirely unless they pay for it--if the
medicines are even available in pharmacies and at clinics--out of
pocket. Given the costs of ARVs and high levels of poverty, that
is not an option for most people in Uganda or elsewhere in the
developing world.
The findings of this issue of Missing the Target make it
painfully clear that Uganda is not alone. The invaluable research
by local advocates in the six focus countries--India, Kenya,
Latvia, Malawi, Swaziland and Venezuela--acknowledges and
highlights the remarkable progress made over the past decade in
increasing access to HIV treatment, prevention and care services
around the world. Yet even though contexts and challenges differ
in the six countries, all face major constraints on their ability
to increase and sustain HIV treatment scale-up. They need
substantially more, not less or incrementally increasing,
financial and technical support. Their own governments can and
must do more, but they cannot cover the gaps on their own. Nor
should they be expected to. The international community must
remember that achieving universal access was once seen as a
necessary global priority toward which all partners would
contribute.
This step should be complemented by redoubled efforts by advocates
and policymakers to understand and combat another trend gaining
influence in recent years: that "too much" money is spent on
AIDS. This argument, which is part of the so-called backlash
against disease-specific funding and programming (including for
HIV/AIDS), is based on a belief that money spent on AIDS would be
better spent from a cost- benefit analysis on addressing other
health needs or for broader investments in health systems.
Such assumptions and calculations are not only heartless but
misguided. For one thing, there is no finite amount of resources
for global health or--as evidenced by the hundreds of billions of
dollars found by the United States and other governments for
domestic economic stimulus in the past two years--for any other
priority. AIDS should have been on a priority list for stimulus
money, considering the sheer numbers and carnage in its wake. It
doesn't get too much money; instead, it and other global health
needs all get far less than they should. Political will, not
available resources, is the real obstacle.
This Missing the Target report is an important reminder that
despite all we have gained, we stand to lose it all and much
more. The HIV epidemic is a global epidemic that requires global
solutions. The drive for universal access was such a solution
because not only did it (at least initially) more closely link
countries of different needs and resources, but it also began the
important process of closing gaps within countries. HIV remains
a highly stigmatized disease. It can only become less so when
treatment is available to all in need, including members of
vulnerable populations such as women, injecting drug users and
men who have sex with men. Without the promise of treatment,
these individuals will remain on the margins of society in many
countries, thereby reinforcing discrimination and stigma. The
future of all nations and the world overall cannot afford to let
that happen.
Peter Mugyenyi Executive Director Joint Clinical Research Centre
Kampala, Uganda
Executive Summary
The six country reports of Missing The Target 8 show early warning
signs of the negative impact of the global backtracking on AIDS
commitment and funding--some governments are beginning to cap the
number of people enrolled in treatment programmes and drug
stockouts are more frequent. If this trend continues, the result
will be suffering and death for millions of people around the
world currently living with HIV and the millions more who will be
newly infected this year and the years to come.
Funding from major donors such as the Global Fund to Fight AIDS,
Tuberculosis and Malaria and the U.S. President's Emergency Plan
for AIDS Relief (PEPFAR) is stalling or flatlining, and reports
from several African countries over the past year (the Democratic
Republic of Congo, Mozambique, South Africa, Uganda and Zambia,
for example) indicate that their government-run antiretroviral
treatment (ART) programmes are turning patients away because of
cuts in both domestic and external funding.
Stalling the AIDS response dooms the effort for stronger health
systems that is now popular among major donors. It will not be
possible to build sustainable, credible health systems as the
waiting lines for AIDS drugs grow. The report's findings clearly
demonstrate that programmes that have achieved hard-won successes
against AIDS are now being starved of financial support--a
development that prevents them from coming close to the goal of
delivering universal access to HIV treatment, prevention and care
by 2010.
Today, some 4 million people have access to HIV treatment but
another 6 million people who need treatment do not have it. New
guidelines from the World Health Organization (WHO) recommend that
ART be started sooner in the course of HIV infection to preserve
health and prevent transmission. Millions of lives depend on the
continued scale up of treatment programmes.
The world's progress in tackling AIDS has also had substantial
benefits for health systems strengthening; training of health care
workers; the treatment of TB and other infections; health care for
marginalized and vulnerable groups; and the engagement of civil
society in setting national health policy. Strong political
leadership and increased funding have been crucial to this
progress.
AIDS Funding Cutback: Writing cheques that bounce
G8 and the Global Fund
Promised: $10 billion a year
Delivered: $3 billion a year
2001: Created with the full support of the G8 club of rich
nations, the Global Fund was intended to be a "war chest" worth
$10 billion a year.
2008: Paltry donations followed the bold promises and by 2008,
donors scraped together only $3 billion a year.5 In 2009,
ambitious and sound proposals from developing countries were met
with "efficiency" or budget cuts of 10-25%.
2011-2013: In March 2010, the Global Fund estimated that it would
need $20 billion over the next three years if it is to expand its
funding and help meet the health-related Millennium Development
Goals (MDGs).
Donors are using the global economic crisis as an excuse to
continue short-changing the fund. Some warn that raising even $13
billion (the lowest scenario, which would mean a dramatic slow
down in pace of delivery) is a "huge stretch."
President Obama and PEPFAR
Promised: $48 billion over 5 years
Delivered: Flatlined funding trajectory
2007: Barack Obama pledges $50 billion over five years for PEPFAR
during his campaign.
2008: U.S. Congress commits to $48 billion over five years in
bipartisan legislation endorsed by candidates Obama, McCain and
Clinton.
2010: The global economic crisis is being used as an excuse to
flatline PEPFAR funds compared to much higher year-on-year
increases in previous years, especially from 2006-2009. The
effects are already visible with new patients being turned away
from treatment in PEPFAR-funded programs in Africa.
Short-changing health
African leaders
2001: In the Abuja Declaration, African leaders pledged to
allocate at least 15% of their annual budgets to health spending.
2007: Of the 52 nations, only three countries (Botswana, Djibouti
and Rwanda) attained the target in 2007, while three others
(Burkina Faso, Liberia and Malawi) attained the target for some of
the period between 2001-2007, leaving 46 countries that have yet
to fulfil their commitment even once.
President Obama and the Global Fund
2007: During his campaign, Barack Obama pledges to contribute the
United States' fair share to the Global Fund.
2010-11: U.S. Congress allocates $1.05 billion to the Global Fund,
which is about $1.7 billion less than the country's fair share
towards the Fund's overall needs. In 2011, President Obama is
proposing to cut funding to the Global Fund and provide only $1
billion.
...
The response to AIDS has been remarkable over the past decade, but
the successes are fragile and are vulnerable to quick collapse.
Abandoning the AIDS response now will inevitably lead to a return
to headlines about people dying of AIDS that we read at the
beginning of the decade. Without the continued political will in
tackling AIDS, there is no chance of the world meeting the 2015
Millennium Development Goals (MDGs) by 2015. The consequences of
a retreat on AIDS are severe: millions of needless deaths.
Five current Myths v. current Realities
Myth: Too much money is being spent on AIDS
Reality: Funding for AIDS is billions of dollars short of what is
needed11 o Needed in 2010: $25.1 billion o Invested in 2008: $13.7
billion o Funding gap for 2010: $11.4 billion-- assuming the world
maintains its pre-economic crisis commitment to AIDS.
Myth: Money spent on AIDS is at the expense of other health
needs or investment in health systems
Reality: The total amount of development assistance for health
quadrupled from $5.6 billion in 1990 to $21.8 billion in
2007--much of this catalyzed by the increased funding and
commitments to HIV/AIDS.
Although the Global Fund and PEPFAR are among the largest global
AIDS funders, they are also some of the biggest investors in
health systems, with 35%13 and 32%14 of their respective funding
devoted specifically to health systems strengthening.
Myth: Strengthening health systems alone will help address
health problems including AIDS
Reality: Strong health systems alone do not guarantee equitable
and universal health care. Past public health approaches failed to
reach the most marginalized--women, MSM, sex workers, IDUs, the
very poor and those living in rural areas. Health systems need
both breadth and focus.
Myth: Prevention is more important than treatment
Reality: Activists never pit prevention and treatment against each
other--on the ground they work together. Treatment can enable more
effective prevention by reducing transmission and encouraging
testing and prevention makes treatment affordable.
Myth: AIDS has been addressed unlike maternal health or other
diseases
Reality: The AIDS crisis is not over. AIDS activists have been the
most effective advocates for health in history. The energy and
passion of AIDS activists can be used to build stronger health
systems, and tackle maternal and child health--since all these
issues are interlinked in the first place. Let's stop pitting
disease against disease.
Country Findings
Research conducted for Missing the Target 8 in six countries
(India, Kenya, Latvia, Malawi, Swaziland and Venezuela) has
revealed that access to treatment for people living with HIV
(PLHIV), while making some gains, remains hindered by a variety of
barriers in their countries.
From high-burden and relatively poor nations in sub-Saharan Africa
(such as Kenya, Malawi, and Swaziland), to large emerging economies
(India), to middle-income countries with relatively small epidemics
(Latvia, Venezuela), in-country researchers found that the future
of even the currently inadequate treatment programmes are in
question. At a time when international guidelines are calling for
more people to be put on treatment both for their own health and
to more effectively control the AIDS epidemic, countries are
headed backwards. Governments are finding various ways to cap the
number of people enrolled in treatment programmes. Stock-outs of
medicines to treat opportunistic infections (OIs) have become more
common, and diagnostics machines are lacking in quantity and/or
quality at the very time that they are needed more than ever,
given the changes to the WHO guidelines for treatment initiation.
In all of these countries, PLHIV are struggling to cover the many
uncovered costs of, for example, OI medications, medical
consultations, transport costs, food, and second-line medications.
Also in many countries, laws to protect vulnerable and
marginalized groups like MSM and sex workers are still lacking,
and many PLHIV interviewed spoke of high levels of discrimination
in health care settings. Several countries continue to give
confusing advice about infant feeding options and use single-dose
nevirapine as the prophylaxis to prevent vertical transmission of
HIV contrary to WHO guidelines. Finally, weak health systems, many
plagued by great shortages of health care workers, lead to poor
conditions and services that impede AIDS treatment and broader
health care access.
In addition to these overarching themes, there were unique findings
in each country:
- In India, a financing gap of $67 million remains for the
implementation of the National AIDS Control Programme (2007 to
2012). The government has yet to meet its commitment on diagnostic
testing in terms of the frequency, affordability, or quality of
the tests. In addition, important medicines for the treatment of
OIs and TB are not always available at all facilities, while
access to second-line ART is severely limited because of strict
eligibility criteria for the government program and high cost in
the private sector. Prevention of vertical transmission programmes
do not focus on the woman's own health and continue to use a less
effective antiretroviral prophylaxis that is not in line with the
latest WHO guidelines.
- In Kenya, donor cutbacks and a lack of adequate domestic funds
will cause the financing gap for HIV/AIDS treatment and services
to further widen this year--making it even more unlikely that the
government will meet its universal access goal by 2013. PLHIV
struggle with the burdens of the costs of important health care
services, including medicines, consultations and diagnostics to
treat OIs and many inpatient services, as well as transportation
and nutrition costs. Lack of sufficient--and sufficiently
trained--health care workers is a chronic problem, and in rural
areas in particular, there are too few facilities providing ART.
HIV-related stigma throughout society continues to hinder many
people from seeking out HIV services, from testing to ART.
- In Latvia, as part of its budget-tightening steps in the face of
a severe economic downturn, the government is cutting the HIV and
health services budget and imposing restrictions on the number of
PLHIV provided with ART free of charge. Generic medicines are not
procured, and as a result, the cost of treatment to the government
is shockingly high compared to many other middle-income countries.
Many primary care providers are reluctant to treat PLHIV because
they have insufficient or limited knowledge about HIV, or because
of the stigma associated with illicit drug use. This makes efforts
to decentralize services difficult (currently there is only one
main comprehensive ART centre in Latvia). Lack of integration of
HIV care and drug treatment services is another key reason why
injecting drug users--an especially vulnerable and affected
population in Latvia--lack access to HIV treatment.
- In Malawi, cutbacks in government support for the National AIDS
Commission are causing a reduction in the depth and scope of
HIV/AIDS services. The health care system suffers a severe shortage
of qualified doctors and nurses. The burden of transport and other
out-of-pocket costs bar access to treatment and services for many
PLHIV, and a high percentage of PLHIV entering hospitals for
treatment are not aware of their HIV status. Second-line drugs are
not available to PLHIV, while OI drug stock-outs and limited CD4
testing availability have also been reported.
- In Swaziland, the government has yet to meet the 2001 Abuja
Declaration commitment to allocate at least 15 percent of its
annual budget to the health sector (allocating just 13.5 percent
in its most recent budget, unveiled in April 2010). A lack of HIV
awareness and testing, and trust in traditional health beliefs and
practitioners who are not grounded in the science of HIV, prevent
people from accessing necessary treatment. TB is the leading cause
of death of PLHIV in Swaziland, yet TB programmes have high
default rates. Long lines and delays are reported at hospitals,
where doctors and nurses are too few in number and there is a
limited amount of diagnostic equipment. The costs of obtaining OI
medicines (which are not provided free of charge), consultations,
and transportation bar access for PLHIV to comprehensive HIV
treatment.
- In Venezuela, the National AIDS Program (PNS) lacks up-to-date
and reliable data on the number of people living with HIV and
those in need of ART, however most advocates believe it is growing.
The National AIDS Strategic Plan of 2003-2007 is out of date and
civil society is calling for a new plan to be drafted in
consultation with civil society organizations. Currently, there is
a lack of coordination between government and civil society
organizations in delivering services for PLHIV. In most rural
areas, patients must rely on small outpatient-oriented facilities
that provide only basic services--and most do not offer HIV/AIDS
care, including ART. Limited HIV awareness is a major barrier to
early treatment uptake across the country, and PLHIV cite a lack
of support from health care workers among the reasons for low
adherence to ART regimens. Consequences of a weak health
system--such as long delays for routine services, unsafe and
unhygienic conditions, lack of adequately trained personnel, low
salaries, deterioration of facilities, and shortages of basic
materials--have had negative impacts on the quality and
effectiveness of HIV treatment services.
Treatment access needs remain great, and backtracking will stall
efforts to deliver other health care goals as well. Improving the
AIDS response has improved health care systems, including by
establishing reliable methods of medicine delivery for all
populations, ensuring quality and availability of diagnostics
equipment, reaching out to vulnerable populations, supporting more
doctors and nurses, and so on--all fundamental blocks of strong
health care systems.
And let us not forget: AIDS is not only a major killer of people
but devastates communities and economies. World leaders who rushed
to plow money and effort into bailing out the financial
institutions that caused the global economic crisis cannot justify
short-changing a crisis that kills over 5,000 people each day.
Let's prevent the tragedy of letting our progress fall apart, just
at a time when the return on investment--lives saved--is beginning
to pay off.
Our Recommendations
Priority actions at the global level aimed at improving access to
AIDS treatment and care include the following:
1. Donor governments: Pay up--contribute your fair share to the
global fight against AIDS.
Rich countries and leaders should not abandon their political
commitment to tackling AIDS just as we see some glimmers of hope.
Sixty percent of people who need HIV treatment still do not have it
and many more should receive treatment if we are to stop over
7,000 new infections every day.
2. Developing country governments: Make the health of your
citizens a top priority in your budget.
Hungry and sick people cannot contribute to the growth of their
nation. The economic and political cost of not saving the lives of
your people is far higher than the increased resources required to
effectively control HIV/AIDS or meet their basic health needs.
3. UNAIDS: Reject universal access targets set by some governments
that do not aim to provide equitable access for all. Setting a low
bar does nothing to advance the cause of why AIDS should continue
to remain high on the global political agenda. The goals are
achievable and the excuses are wearing thin.
4. Health and social justice movements: Unite to demolish the
"AIDS backlash" that seeks to pit disease against disease or food
against medicines.
Activists know that communities do not live their lives in separate
programmatic areas--a young HIV-positive woman in a rural area does
not just need ARVs, but a means of earning a living, adequate food
to feed herself and her family, a functioning antenatal clinic and
the right to live free of discrimination and violence. We need to
mobilize against the false debates taking place in hallowed
circles far away from the realities of this young woman.
5. Donors and international agencies: Put your money where your
mouth is and pledge extra resources to end the crisis of health
workers and health systems.
It is not AIDS that is starving the health systems but wrongheaded
macroeconomic policies and decades of underinvestment. The answer
is not to cut AIDS or vertical funding and go back to old ways of
providing "generalized health support". The latter did not achieve
as much for the health of people as the AIDS movement which has
delivered measurable progress in numbers of lives saved; in
reducing the cost of medicines; in building up crumbling health
systems; in improved training for nurses and doctors and most
importantly in securing more resources for other neglected
diseases and health overall.
6. Governments and international agencies: Build on the public
health lesson that AIDS has taught us - without reaching women,
children, MSM, sex workers, IDUs, your efforts to control AIDS will
fail. Public health can be advanced only when the fundamental human
rights of the most marginalized and vulnerable groups are
respected, protected and fulfilled. Criminalizing MSM, sex workers
and IDUs and discrimination and violence against women remain
major barriers to effective AIDS programmes and the goal of
universal access. The AIDS response has shown how much more can be
achieved when governments meaningfully engage and work together
with representatives of civil society, in particular, those most
affected by the disease.
AfricaFocus Bulletin is an independent electronic publication
providing reposted commentary and analysis on African issues, with
a particular focus on U.S. and international policies. AfricaFocus
Bulletin is edited by William Minter.
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