Going backwards on the fight against AIDS: What to tell the patients?

© Brendan Bannon

Soon, it will be necessary to explain why big banks have access to emergency rescue measures and not patients infected with HIV and tuberculosis, or mothers who lose their children to malaria.

The cancellation last week of Round 11 of the Global Fund (1) to fight AIDS, tuberculosis and malaria has hit patients, activists and caregivers hard. In the last ten years, significant progress in the uphill battle against these deadly diseases has been made.  However, never has the hope of dealing a fatal blow to the epidemics of our time been greater than in recent months. 

Encouraging results from a number of studies have shown the considerable scientific impact that antiretroviral (ARV) treatment has on preventing the transmission of the HIV virus, and on the overall health of those infected. These latest advances have brought medical organisations such as Médecins Sans Frontières (MSF) to focus more on developing preventative treatment strategies, with the aim of reducing transmission. The new measures, adapted to medical contexts with a high HIV prevalence, are designed to promote discussion with the ministries of health in specific countries, to help facilitate quick implementation.

Today, most fieldworkers in daily contact with patients are more concerned with how they will save the thousands of lives threatened by the lack of funds, than how new infections can be prevented.  At its inception, the Global Fund raised hopes that the efforts of fieldworkers would have strong financial support, which would undoubtedly lead to a victory against these great epidemics. The major donor countries publicly pledged,  after the United States, to support the unique initiative of continuing donations. Consequently they helped silence the sceptics of international cooperation in regard to the provision of healthcare to the most vulnerable.

However, it was not foreseen that the major governing powers would turn their backs in the midst of a global economic slowdown. Today, these leaders are thinking more about satisfying domestic needs and interests, than honouring 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 healthcare 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, or to bear the financial costs associated with implementing such ambitious, yet effective, strategies. It is perfectly legitimate and expected that such mechanisms as the Global Fund be relied on to achieve these goals, giving the hope of leading healthy and productive lives to millions of people. 

The cancellation of Round 11 has brought to a halt the positive momentum that had spread across the community of patients and caregivers worldwide. In countries such as Swaziland, HIV prevalence is at record levels (26 per cent of the adult population), and health actors are working hard to stem the epidemic in difficult economic conditions.

The financial disengagement of major donors will have considerable impact on patients currently under treatment. Quite simply, if pledges to the Global Fund are not met, there are tens of thousands of lives at stake. In addition, 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 neighbouring Mozambique, where 240,000 people are on ARVs and the same number of people are waiting to begin treatment, the axe will fall even sooner for many.

This is reminiscent of the beginning of the year 2000, when caregivers had to choose which of their patients had the greater chance of surviving. This choice 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.