SOUTHERN AFRICA: Same problems, less funding

Photo: Laura Lopez Gonzalez/IRIN

Long walks, long waits for treatment

JOHANNESBURG, 4 May 2010 (PlusNews) - Without adequate funding, barriers to HIV treatment are likely to remain unchanged in spite of growing demand, a new report has warned.

A new report by the International Treatment Preparedness Coalition (ITPC) looked at national HIV programmes in Malawi and Swaziland as part of a six-country focus that spanned Eastern Europe, Asia, Latin America and Africa.

The ITPC, an international treatment lobby group, noted in its report, Rationing Funds, Risking Lives: World backtracks on HIV treatment, that poor health infrastructure, high costs and staff shortages have kept HIV treatment uptake low in Malawi and Swaziland.

In addition, antiretroviral (ARV) programmes in the two countries have been compromised by lower levels of international funding.

In both countries people living with HIV had to travel long distances, often followed by long waiting times once they got to the clinic, due to the uneven distribution of health centres and staff shortages. Shortages of ARV drugs reflected "early warning signs of the negative impact of the global backtracking on AIDS commitment and funding", the ITPC commented.

Malawi has an HIV prevalence rate of about 12 percent; according to UNAIDS more than 90 percent of its HIV response is donor-funded. ARVs are free in the public sector, but the report pointed out that transport costs for trips - sometimes up to 35km - often made obtaining the drugs unaffordable.

The country began training its own doctors and nurses about 30 years ago; it has an estimated shortfall of 160,000 health workers but only produces about 10,000 annually.

Mind the gap

Swaziland boasts the world's highest HIV prevalence rate - about 26 percent - with about 50,000 people on treatment, according to Derek von Wissell, director of the National Emergency Response Council on HIV/AIDS (NERCHA).

Shortages of ARV drugs reflected 'early warning signs of the negative impact of global backtracking on AIDS commitment and funding

In recent years, the government has moved to become the primary funder of treatment, yet the ITPC report noted that poor wages and working conditions continued to drive Swazi healthcare staff out of the public sector.

Von Wissell said downturns in donor funding had affected the fight against HIV, more so in HIV prevention and support services to orphans and vulnerable children (OVC) than treatment provision.

HIV prevention was often a budgetary afterthought, receiving whatever was left over after allocations to HIV treatment and diagnostic services had been made. With constricted funding, child grants to support OVC were likely to remain on the drawing board, he told IRIN/PlusNews.

The World Health Organization (WHO) recently issued new HIV treatment guidelines, but Von Wissell said funding would determine how quickly Swaziland could conform. Raising the CD4 count threshold for starting treatment, as suggested in the new guidelines, would greatly increase the number of those eligible for treatment, he said.

Malawi recently released the results of a study funded by WHO to investigate what adhering to the new WHO guidelines would mean. It found that initiating patients on ARVs sooner, at the new higher CD4 count of 350, would increase the number of those eligible for treatment by about 50 percent, making international funding even more crucial.

The ITPC report made a number of recommendations, including that international donors honour their previous funding commitments, and that governments make health a priority in their national budgets.

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