Global Fight Against HIV/AIDS At Crossroads: Australia Should Take A Lead

The global fight against HIV/AIDS, an epidemic that killed around 1.8 million people last year, is at a critical crossroads. On one hand, new scientific evidence offers promise to finally stem – if not reverse – the epidemic and governments have given ambitious commitments. Sadly, on the other, the funding needed to turn this year’s scientific and political breakthroughs into increased access to treatment for millions of people is severely lacking, threatening to undermine not only future advancements but also existing programs and ultimately denying people live-saving treatments. Now is a critical moment for key international donors such as Australia to ensure that that this opportunity to save millions of lives is not lost.

During our ten years of providing antiretroviral treatments to HIV patients in resource poor settings Médecins Sans Frontières/Doctors Without Borders has witnessed time and again how treatment dramatically reduces illness and deaths in the communities where we work. Now landmark scientific evidence released this year shows that early HIV treatment not only saves lives but also reduces the risk of new infections to a partner by 96 percent. This shows that HIV transmission can be significantly reduced if more people are placed on HIV treatment earlier in their disease progression. According to UNAIDS, expanding treatment and pairing it with other high impact interventions can avert more than seven million deaths and twelve million new infections by 2020.

In recognition of these findings, the UN agreed to a bold new declaration to fight AIDS, which Australia played a lead role in getting all UN member states to endorse in June this year. This included the target of increasing the number of people on HIV treatment to 15 million by 2015, from 6.6 million today. Sadly, drastic funding shortfalls stand to jeopardize this opportunity to finally curtail this epidemic.

The Global Fund to Fight AIDS, TB and Malaria, the largest multilateral funder of HIV treatment, financing more than 70% of antiretroviral drugs in resource poor countries, is facing serious funding shortages. As a result the Fund was forced to cancel an entire round of funding, an unprecedented event in its 10-year history. The impact will be devastating. If countries are left without the support they need to provide HIV treatment to new patients, people in need will be forced to wait for prolonged periods. Treatment rationing may also be on the horizon, with doctors having to select patients to give treatment to rather than providing it to all those who seek it. In Southern Africa, where Médecins Sans Frontières has been running HIV/AIDS programs for the past 10 years, we know treatment rationing all too well, having started treatment when there was not enough funding to cover the then high-price of drugs. It seems unthinkable to me that today, when the science and political will are behind us, that people living with HIV cannot access the affordable life-saving treatment they urgently need.

Médecins Sans Frontières teams on the ground have surveyed national HIV/AIDS programmes in areas where we work in an effort to provide a clearer picture of national ambitions and the threats these nations face in fighting the epidemic.  Médecins Sans Frontières found that several countries have been forced to scale back ambitious strategies because of stagnant or declining budgets.  And more worryingly, in some countries such as the Democratic Republic of Congo, Mozambique and Zimbabwe, existing national treatment programmes are under threat of being severely curtailed, effectively reversing progress. For example, funding shortfalls threaten to interrupt treatment for up to 112,800 patients already on antiretroviral drugs in Zimbabwe by 2014. Mozambique expects to face shortages of first-line antiretroviral treatments by the end of 2012. Myanmar will also be seriously impacted by the funding shortfall, with predictions that more than half of the people in need will be unable to receive antiretroviral drugs by the end of 2015.

There is an urgent need for international donors to step up to the plate to provide the funding needed. Australia has been a leader, not only in the region but also internationally, in the fight against HIV/AIDS. This was highlighted by Tuesday’s announcement that the XX International AIDS Society’s conference on HIV and AIDS, the world’s largest, is to be held in Melbourne in 2014. While some other donors have been reducing or even freezing funding for the Global Fund, Australia increased its contribution by 55 per cent for the three year period 2011 to 2013. In this moment as we stand on the brink of actually being able to stem, and maybe even reverse HIV/AIDS, the leadership of major donor countries like Australia is vital. Médecins Sans Frontières urges Australia to boldly step into this leadership role by providing continued and increased funding for HIV/AIDS programs and proactively advocating that all countries do the same. 2012 will be a critical year for the global fight against HIV/AIDS, where we can either make significant inroads, or let the opportunity to save millions of lives be squandered. I hope that next World Aids Day Australia can reflect proudly on its leadership in successfully combating the most deadly epidemic of our generation.

By Kelly Nicholls, Médecins Sans Frontières Australia

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