AFRICA: Funding shortfalls foil new treatment guidelines

Photo: Kate Holt/IRIN

"How will we now put so many more people on ARVs?"

NAIROBI, 9 March 2010 (PlusNews) - Global funding shortfalls for fighting AIDS could make it impossible for developing countries to implement new World Health Organization treatment guidelines, activists have said.

WHO released new guidelines on antiretroviral therapy (ART) in December 2009, raising the CD4 count - a measure of immune strength - at which HIV-positive people should start ART from 200 to 350. Research has shown that starting ART earlier reduces the rate of death and opportunistic disease.

"WHO's new recommendations are excellent in theory, but they did not give us a practical way of implementing the guidelines - already we have shortages of drugs in trying to put people with CD4s below 200 on treatment," said James Kamau, coordinator of the Kenya Treatment Access Movement.

"How will we now put so many more people on ARVs? The increased number of people on drugs means not just more drugs, but more labs, more health centres and health workers, more general care - the expense is enormous."

An estimated four million people around the world are currently on ART - a 10-fold increase since 2003, when the drugs became widely available - but this figure still represents just over one-third of the people who need the medication.

"If WHO's new recommendations are not implemented, the international community risks subsidising less expensive yet sub-standard care for developing countries," said Sharonann Lynch, MSF's HIV/AIDS policy advisor, in a press release.

"Avoiding this will depend on the willingness of donors to make new commitments. Although this is not easy in today's financial environment, donor countries cannot back away from supporting the promise of universal access to treatment made five years ago."

"The situation is now an emergency"

In Uganda, where the government plans to release new treatment guidelines reflecting WHO's recommendations, officials said the number of people needing treatment would rise from 300,000 to about 750,000. The country recently suffered drug shortages in its public health sector, partially caused by funding problems.

The situation is now an emergency: new treatment enrolments in many countries are coming to a standstill, the risk of drug resistance is increasing

"The numbers will be too great for us to manage," said Dr David Kigawalama, head of prevention services at the Uganda AIDS Commission. "We need to sit with our AIDS development partners to forge a way forward."

Ahead of a high-level meeting between Group of Eight (G8) leaders and AIDS advocates in London on 10 March, AIDS activists met with British International Development Minister Gareth Thomas on 9 March and called on the world's wealthiest nations to honour their 2005 Gleneagles pledge to achieve universal access to HIV prevention, treatment and care by 2010.

"Instead of building on progress, some donor nations and governments of highly affected countries are backing away from the universal access commitment with a series of poorly funded half-measures on AIDS," the executive director of the International AIDS Society, Robin Gorna, said in a press statement.

"The situation is now an emergency: new treatment enrolments in many countries are coming to a standstill, the risk of drug resistance is increasing, and fragile gains made over the last 10 years may soon erode, with potentially serious consequences for future efforts to control this epidemic."

The activists singled out Canada - the only G8 nation firmly opposed to the Financial Transactions Tax, a tiny tax on financial transactions that could raise the billions of dollars needed to fulfil the universal access pledge.

The global economic downturn forced the Global Fund to Fight AIDS, Tuberculosis and Malaria, the world's largest funder, to cut disbursements by 10 percent in 2008, while the US President's Emergency Plan for AIDS Relief (PEPFAR) has flat-lined funding to many countries, limiting the growth of PEPFAR-funded treatment programmes.

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