One of the
dominant themes at the recent International AIDS Conference in Vienna was how to maintain
the momentum towards universal HIV treatment access in the context of a global
economic slowdown.
It is estimated that
the Global Fund to Fight HIV, TB and Malaria, which funds treatment for 2.5
million of the 5.2 million people on HIV treatment in the world, will need up
to US$2 billion over the next two years just to maintain the present number it
supports. That figure doesn’t include funding for the extra million people that
will need drugs if new World Health Organization guidelines to treat at CD4
counts below 350 are to be followed, let alone expanding treatment further. It
is estimated that still only a third of the people with HIV in the world who
need treatment are getting it.
The Fund has
committed itself to pay for programmes worth $4-6 billion more than it has
money to pay for, and given that its second-largest contributor, the European
Union, actually reduced its contribution by $600 million last year, there was a
lot of nervous questioning in Vienna
about whether we would see reversals in treatment access.
HIV activists
have also criticised the current US President, Barack Obama, for ‘flatlining’
funding for the President’s Executive Plan for AIDS Relief (PEPFAR) programme,
which funds HIV drugs for two million people. Proposals to expand the mandate
of the fund to cover maternal and child health could result in reductions in
the funds available for HIV treatment.
There have
certainly been reports of drug stockouts and people being forced off treatment
from Uganda, from Russia and even in the USA, where 1700 people are
currently on waiting lists for state-funded HIV treatment.
Ex-US president
Bill Clinton, addressing the conference, had two messages, one optimistic and
one sobering.
The optimistic
one is that we seem to be turning the corner of the epidemic in terms of new
infections. Global HIV prevalence has fallen by 17% in the last decade, partly
due to better prevention, and there have been much more dramatic declines in
incidence in young people in some countries – a 60% drop in young women in South Africa,
for instance.
This appears to
have been driven by behaviour change, but there is also evidence from some
sources that HIV treatment is starting to have an impact on HIV incidence too,
as the ‘take the test’ habit grows. Clinton
said that the proportion of people in low- and middle-income countries who know
their HIV status more than doubled from 15% in 2005-6 to 39% in 2007-8.
The sobering
side of Clinton’s
message, however, was that we could not rely on the mechanisms that have led to
the remarkable expansion of HIV treatment into the developing world to keep the
momentum going into the next decade.
He warned that
newer funding mechanisms would have to complement the Global Fund/PEPFAR
state-philanthropy model. Developing countries, many of whom had the resources
to do it, needed to start funding more HIV treatment for their own populations
– a criticism heard at other presentations during the conference.
Whereas South
Africa, for instance, has committed itself to expand its own support for HIV
treatment end prevention, the populous and oil-rich country of Nigeria still
relies on international donors for 80% of its HIV treatment budget and
currently treats only 40% of its population in need.
Dr Michael
Kayode Ogungbemi of Nigeria’s
National Agency for the Control of AIDS said: “The country has enough resources
to give all the people who require antiretroviral therapy access to treatment.
But the priorities of government are sometimes not informed by evidence or
rational decisions.”
Clinton also said a massive increase was needed
in private support for HIV. With the exception of a few billionaires like Bill Gates,
Clinton said,
the way forward was “to raise a massive amount of money in small amounts, by
user-friendly means.” He gave as examples the air-ticket levy started by France
which now fuels the UNITAID HIV treatment fund, the main supporter of his own Clinton
HIV/AIDS Initiative, and schemes like SMS fundraising where people can donate
to campaigns like the Haiti earthquake and Pakistan flood appeals by sending a
one-word text.
Finally, he
praised task-shifting: the training of nurses, community volunteers, and people
with HIV to administer HIV testing, drug distribution and education/counselling
to communities instead of doctors. South Africa had saved $300 million
with its own task-shifting scheme, he said, and other countries needed to
follow suit.
Clinton finished
with a five-point plan to enable the continued expansion of HIV treatment:
resist calls to deprioritise HIV; campaign for further drug price reductions,
especially of tenofovir and second-line regimens; achieve large reductions in
other treatment-associated costs; build better private donation structures; and
“educate people why this is good”.
For more
coverage of the conference, visit www.aidsmap.com/vienna2010.
The full news
report on Clinton’s
speech, including a link to a webcast of the session is available at
www.aidsmap.com/page/1448242.