Zimbabwe: HIV patients should not bear financial burden of donor retreat
MSF, which supports treatment for more than 228,750 HIV patients in more than 20 countries, is deeply concerned by these and similar proposals that involve shifting the financial burden of buying ARVs from state budgets and donor funds to HIV patients themselves. This idea is being aired as international donors continue to retreat from previous funding commitments on ARVs, thus cutting off access to lifesaving treatment for patients in resource poor settings. Countries are struggling more than ever to find additional alternative sources of funding in order to avoid a return to rationing treatment and undoing much of the progress that has been made in HIV care over the past two decades. Interrupting treatment will also contribute to the growth of resistant strains of the virus.
In Zimbabwe, ARVs are not currently covered by the Health Transition Fund (HTF), which creates serious problems. Until end 2011, a pool of funds financed by the UK, Sweden, Norway, Ireland and Canada paid for ARVs. This year, the HTF, absorbed this pool, but purchasing ARVs was no longer part of its mandate. This means that some 66,000 patients already on treatment do not know where their ARVs will come from, to say nothing about people waiting to begin treatment. If donors, such as the United States, European member states or the European Commission through the HTF, do not mobilize to cover the gap, the next opportunity for additional funding would be a grant from the Global Fund to Fight AIDS, Tuberculosis and Malaria. The earliest that would happen, however, if it happened at all, would likely be in 2014.
The funding shortfalls have sparked much debate and calls from UNAIDS and others for countries gripped by the HIV crisis to step up domestic efforts. It is certainly true that national governments and ministries of health must make both political and monetary commitments to treating HIV. But passing the burden on to the patients themselves is not the answer. That would mean expecting people who are already vulnerable to pay for treatment that should be free; it also jeopardises the gains and results treatment programmes have made.
The World Health Organization—backed by medical evidence—holds that guaranteeing ARVs free of charge is crucial to maintaining good treatment outcomes and to slowing the spread of HIV. Most people accessing ARVs in high-burden countries through government health care, as in
To make vulnerable patients in poor resource settings pay for ARVs goes far beyond reasonable expectations. What’s more, fees collected from patients in a country where 80-90 percent of the population is not formally employed will not amount to much. And we know from experience that patients with unpredictable incomes may start rationing their ARV intake, taking less than the recommended dosages of pills in order to make drug supplies last longer. This leads to added complications, drug resistance and interrupted virus suppression—all of which would further increase the cost of care, wiping out any savings generated by the imposition of fees. In turn, it would increasingly burden health services, discourage health workers, and, worst of all, deter people from coming forward for testing and treatment.
A great deal of progress has been made in the fight against HIV/AIDS in
Therefore, MSF urges donors to make sufficient funding available for free and effective HIV treatment to all who need it. Domestic resources must be augmented with consistent and continued international involvement. Only then can we curb the HIV epidemic in