Slowed funding imperils global gains against AIDS, Doctors Without Borders says

By Karin Brulliard
Washington Post Foreign Service
Friday, November 6, 2009

JOHANNESBURG -- Slowed funding from international donors, including the United States, is imperiling recent dramatic gains in treating AIDS patients in the developing world, according to a new report.

Billions of aid dollars channeled toward the epidemic in the past decade have helped provide life-prolonging drugs to more than 4 million people, but the rate of infection still outpaces that of treatment. Now the global economic crisis and other factors are causing financial support to taper, undermining progress in nations such as Uganda, where some clinics are refusing new patients or accepting them only after a current patient dies, according to the report by Doctors Without Borders.

Those are early signs of the manifestation of a dilemma some public health experts warned about after President George W. Bush launched a multibillion-dollar U.S. AIDS fund that now pays for the treatment of more than 2 million people. Because the medication must be taken for life, some said, the United States was essentially committing to fund treatment indefinitely -- and had a moral duty to do so.

But after years of expansion, funding for the President's Emergency Plan for AIDS Relief, or PEPFAR, has leveled off, and less of its budget is dedicated to treatment, according to the report. President Obama, during last year's campaign, promised to increase funding, but it has remained about level since he took office.

"The donors, I think, are getting cold feet about committing to a long-term, chronic disease," Tido von Schoen-Angerer, director of Doctors Without Borders' Campaign for Access to Essential Medicines, told reporters Thursday. "Lives are in the balance as donors are backtracking on funding commitments."

Cuts are also threatening the Global Fund to Fight AIDS, Tuberculosis and Malaria, which distributes nearly a quarter of all HIV/AIDS donor money, according to the report. But shortfalls have caused the fund, whose main contributors are the United States and European countries, to cut approved grants by 10 percent and to consider canceling a 2010 funding round, the report said.

Though the global funding retreat has not yet resulted in major cuts to AIDS treatment, it is threatening its growth, or "scale-up," said officials with Doctors Without Borders.

Continued expansion is key to fulfilling a pledge by the world's wealthiest nations to provide "universal access" to antiretroviral medication -- defined as treating 80 percent of the population. About 6 million people worldwide, the vast majority in sub-Saharan Africa, still lack access to the drugs.

U.S. officials have said that they remain committed to PEPFAR but that a tightened economic climate necessitates sustaining, not growing, programs.

"The landscape around us is changing, with the need to balance a broad portfolio of global challenges at a time of financial crisis," Eric Goosby, the U.S. global AIDS coordinator, wrote in an August letter to American ambassadors. "As a result, we need to plan for the next stage of PEPFAR's development in this context and cannot assume the dramatic funding growth of PEPFAR's early years will be repeated."

Though they acknowledged that the economic crisis had shrunk donor budgets, officials with Doctors Without Borders asserted that "political" motivations were also driving funding withdrawals. They criticized intensifying claims by some public health researchers that a disproportionate amount of global health funding goes to AIDS programs at the expense of cheaper treatments for more deadly illnesses such as diarrhea.

A recent study published in the Lancet medical journal found that 23 percent of global health funding in developing countries has gone to fight AIDS, while programs to tackle tuberculosis and malaria -- which together kill more people -- have received one-third as much.

In announcing a $63 billion, six-year "global health initiative" this year, Obama seemed to acknowledge that assessment, pledging to broaden the U.S. approach to global health by focusing on tropical diseases and other preventable illnesses, in addition to AIDS.

"Some policymakers say AIDS is expensive, we should focus on cheap and easy things," von Schoen-Angerer said. "This cannot be an either-or game. . . . It's not that HIV is overfunded. Global health is underfunded."

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