Swaziland: Going backwards on the fight against Aids: What to tell the patients?
Aymeric Péguillan - Head of Mission with Médecins Sans Frontières in Swaziland.
Soon it will be necessary to explain to patients infected with HIV, simple and multi-drug resistant strains of tuberculosis, and to the mothers who each year loose their children to malaria, why big banks have access to emergency rescue measures and not them.
The cancelation last week of Round 11 of the Global Fund1 to fight AIDS, tuberculosis and malaria is a large hit to those patients, activists and caregivers, who for 10 years have accomplished significant progress in the uphill battle against these deadly diseases. Never has the hope of dealing a fatal blow to the epidemics of our time been so great than in recent months. Encouraging results were published from a number of studies showing the considerable scientific impact that antiretrovirals (ARV) have on preventing the transmission of the HIV virus from an HIV-positive patient to an uninfected person, and more simply on the overall health of those infected.
These latest advances have brought medical organisations such as Médecins Sans Frontières, to seriously focus on developing preventative treatment strategies aiming to reduce transmission. The new measures, adapted for medical contexts presenting a high prevalence of HIV, are additionally designed to engage discussion with the specific countries’ health ministries to guide their implementation quickly.
It is sufficient to say that today, most of the field workers in daily contact with patients think more about how they will save thousands of lives threatened by lack of funds, rather than how they will prevent new infections. At its inception, the Global Fund raised hopes that the efforts of field workers would be supported by a strong financial mechanism, that would undoubtedly lead to a victory against these great epidemics. The major donor countries pledged publicly behind the United States to support this unique initiative by continuing donations and consequently silencing the skeptics of international cooperation on health to benefit the most vulnerable.
But, as it seems, it was not foreseen that the major governing powers would turn their backs in the midst of a global economic slowdown. Today, these leaders think more about satisfying domestic needs and interests, than honoring their commitments, which millions of lives depend on.
Enormous challenges for patients
It would be too easy to allow these challenges to fall by the wayside of this cowardly denial. Many countries, mostly situated in Sub-Saharan Africa, are currently attempting to implement health care systems adapted to the needs of patients infected with HIV, tuberculosis and malaria. There is no doubt that despite the present difficulties and fragile Ministry of Health management systems, a political will has been established to battle head-on the three major epidemics in seriously affected countries. But even if the political will is there, it remains clear that these states are, at present, unable to lead the battle alone to bear the financial costs associated with implementing such ambitious, yet effective, strategies. It is perfectly legitimate and expected that they rely on such mechanisms as the Global Fund to achieve these goals and give hope to millions of people to lead healthy and productive lives.
The cancellation of Round 11 has brought to a halt the positive momentum that spread across the community of patients and caregivers worldwide. In countries such as Swaziland, HIV prevalence is at record levels (26% of the adult population), and health actors are working hard to stem the epidemic in difficult economic conditions; quite simply if pledges to the Global Fund are not met, there are tens of thousands of lives at stake. The financial disengagement of major donors will have considerable impact on the patients currently under treatment, part of which therefore is suddenly deprived. Additionally, those who are eligible and waiting for their treatment to begin will be sent home for lack of available drugs.
In Swaziland, where almost 68,000 people are on treatment, medication shortages will be felt in 2012. In Mozambique, a neighboring country with 240,000 people on ARVs and the same amount waiting to begin treatment, the ax will fall even sooner for many of them.
This will signify a return to the beginning of the year 2000, when caregivers had to chose which of their patients had the greater chance to survive. A choice that is totally unacceptable and inconceivable in 2011. Who will explain to all of these patients that they can no longer be treated?
1. The funds from the different Rounds of the Global Fund serve as annual allowances allocated to countries who have requested support for their national programs on the fight against AIDS, tuberculosis and malaria.
Aymeric Péguillan is Head of Mission with Médecins Sans Frontières in Swaziland.