Faced with the global economic downturn and less money from donors, national HIV programmes in East and Southern Africa – the region hardest hit by HIV/AIDS – are struggling to stay afloat. IRIN/PlusNews brings you a wrap of countries feeling the biggest pinch.
Democratic Republic of Congo (DRC)
According to medical relief agency Médecins Sans Frontières (MSF), funding shortfalls caused the government to cap the number of people starting on antiretroviral (ARV) treatment at 2,000 new patients for 2011, even though an estimated 15,000 people are on waiting lists for the drugs. Only 12 percent of those in need of the life-prolonging medication are receiving it.
NGOs have been asked by the Ministry of Health to limit HIV testing because there is no money available to buy drugs to treat those eligible for ARVs. Access to drugs for opportunistic infections and testing for CD4-counts or viral loads is extremely limited.
DRC is largely dependent on the Global Fund to Fight AIDS, Tuberculosis (TB) and Malaria to finance its treatment programmes, and other donor projects are winding up, making the country even more dependent on dwindling Global Fund grants.
Poor funding in 2010 led HIV care facilities to reduce patient enrolment. Service providers said they were afraid to encourage people to test for HIV in case they needed ARVs and were unable to provide the medication. In August PEPFAR responded to appeals from healthcare providers overwhelmed by patients by making a commitment to increase its support to the national treatment programme.
However, HIV programmes remain poorly funded and Uganda’s appeal for $270 million from the Global Fund in Round 8 was rejected. Although the government now contributes some $60 million annually to buying HIV drugs from a local manufacturer, critics say HIV/AIDS efforts will remain stunted unless the government makes a more meaningful contribution.
In November 2011, South Africa’s leading HIV/AIDS lobby group, the Treatment Action Campaign (TAC), which is largely dependent on the Global Fund, released a statement warning that without this money, TAC will be forced to close its doors and retrench 280 employees in 130 branches at the end of January 2012. TAC volunteers distribute over 5 million condoms a year and the group’s treatment literacy project educates patients about HIV treatment in many of the country’s public health facilities.
As some donors pull out entirely and others shift from programme implementation to technical assistance, many patients who previously got their treatment from well run NGOs are being transferred to already overcrowded public health facilities.
Following a Global Fund rejection of its application for money in November 2007, the government said there was a gap of $83 million to cover all the needs of the national AIDS strategic plan from 2007 to 2011.
In 2010, HIV-positive patients in some parts of the country complained that they were unable to access drugs to treat opportunistic infections and many could not afford a CD4 test, which measures immune strength and is required before health facilities can initiate patients on ARVs.
At the end of June 2011, World Bank funding – more than $50 million over a nine-year period – for Burundi’s AIDS response ended and has not been renewed. The Global Fund and the World Bank have been Burundi’s largest HIV donors. In September, associations of people living with HIV reported that several of their members had died due to an ongoing shortage of ARV drugs.
The country with the highest HIV prevalence has been grappling with shortages of HIV treatment, testing kits and laboratory tests essential for initiating and managing patients on ARV treatment, caused mainly by a drop in revenue from the Southern Africa Customs Union (SACU) as a result of the global economic downturn.
Swaziland recently received emergency funding from PEPFAR to help supply first-line ARVs until the end of April 2012, but further ARV shortages have been predicted.
An estimated 96 percent of the HIV budget is donor-funded, with the Global Fund and PEPFAR providing the largest portion. Mozambique’s Round 9 funding has not yet been released due to concerns over poor financial and supply management, and its Round 10 grant proposal was not approved. Other donors, including the Clinton HIV/AIDS Initiative, have withdrawn support as the UNITAID grant comes to a close.
Mozambique is expected to face shortages of first-line ARVs by the end of 2012 or even earlier, unless an emergency funding request to the Global Fund is approved. The country is looking for other funding alternatives to help bridge the projected shortfall.
HIV/AIDS funding received a blow when the Global Fund rejected its proposals in rounds eight and nine. Kenya has a projected $167 billion shortfall to cover its HIV programmes up to 2013. The country has put more than 400,000 people on ARVs, but another 600,000 need the drugs and have no access to them.
At the end of November 2011, HIV-positive people in Coast Province, eastern Kenya, held demonstrations over the lack of drugs in health facilities, forcing people to purchase the drugs from private pharmacies, but many who can’t afford the drugs are going without.
Kenya’s Cabinet has proposed that the Ministry of Finance create an HIV/AIDS Trust Fund to support scaling up the HIV response. If approved, the government will contribute 1 percent of its annual revenue to the fund.