HIV and AIDS
HIV and AIDS
The global response to the HIV/AIDS epidemic has been unparalleled. Between 2007 and 2008, funding increased from US$11.3 billion to US$ 13.7 billion globally (UNAIDS, Fact Sheet AIDS Funding 2008-09). However, the global economic crisis is having dire consequences for HIV and AIDS funding. These effects are felt particularly in sub-Saharan Africa, which has the highest levels of HIV and AIDS infection in the world, with approximately 25 million people infected. This amounts to more than 60 percent of global infections (Joint Action for Results UNAIDS Outcome Framework). Across the board, HIV/AIDS programmes in Africa are extensively funded by Western donors (UNAIDS and The World Bank, ‘The Global Economic Crisis and HIV Prevention and Treatment Programmes: Vulnerabilities and Impact’).
According to a report released in June 2009 by UNAIDS and the World Bank, entitled ‘The Global Economic Crisis and HIV Prevention and Treatment Programmes: Vulnerabilities and Impact,’ the global economic crisis was expected to significantly disrupt HIV and AIDS prevention and treatment programmes over the course of 2009. The report specifically warned of the consequences of funding cuts. Amongst these consequences were increased mortality and morbidity, unplanned interruptions and curtailed access to treatment, increased risk of HIV transmission, higher future financial costs, an increased burden on health systems and a reversal of economic and social development gains. A survey of countries representing approximately 60 percent of people on antiretrovirals (ARVs) globally found that by the end of 2009, treatment programmes in more than a third of these countries would be directly affected by budget shortfalls, due to the downturn.
In light of the above, this brief will examine the effect that the economic crisis has had on two of the primary HIV and AIDS aid organisations, namely the United States President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis and Malaria. The brief will also scrutinise the impact that funding cuts have already had on various countries around the African continent.
‘Power-houses’ in HIV/AIDS funding falling short of commitments:
PEPFAR was launched in 2003 by former United States President George W. Bush to combat the global HIV and AIDS pandemic. The fund committed itself to providing US$15 billion over five years (2003-2008) in support of the fight against HIV and AIDS. In July 2008, PEPFAR was reauthorised with an impressive US$ 48 billion approved for the 2009 to 2013 financial years. After assuming office, President Barack Obama announced his Global Health Initiative, which saw PEPFAR’s budget extended to US$ 51 billion, but available over a six year period.
Critics have pointed out that these new developments are not in line with the US$48 billion that Obama promised would be rolled out by 2013, or the additional US$1 billion per year increase which he promised during his election campaign. The Global AIDS Alliance (GAA) estimated that the consequent shortfall would lead to one million people not receiving ARV treatment and 2.9 million women not receiving prevention of pregnant mother-to-child transmission (PMTCC) interventions. The GAA also estimated that 27 million people would not have access to sexually transmitted infection (STI) prevention programmes and that 1.9 million orphans and other children affected by or vulnerable to HIV and AIDS would not receive care and support services. Obama’s rationale for the change in funding roll-out centres around the fact that PEPFAR would be working with multilateral organisations such as the Global Fund and UNAIDS, and would be implementing bilateral programmes that adopt a more integrated approach to fighting diseases, improving health, and strengthening health systems.
The Global Fund
The Global Fund to Fight AIDS, Tuberculosis and Malaria was established in 2002 to prevent and treat these three profound health concerns. The Global Fund collaborates with governments, civil society, the private sector and affected communities to combat the disease. It also works closely with other bilateral and multilateral organisations to further supplement existing efforts. Since its inception, the Fund has approved US$15.6 billion to fund 572 programmes in 140 countries. Fifty-seven percent of the fund’s money is channelled to sub-Saharan Africa. The Fund was however also not immune to the effects of the economic crisis. This became evident in a meeting held in November 2008 where the Global Fund’s Board made several important decisions to deal with the shortfall in available resources.
Among the changes to funding which had to be made was that all grants approved for funding in Round 8 would have to be decreased by 10 percent. Round 9 was to be postponed by six months and to be the only round in 2009. Additionally, Phase II (years 3 through 5) of existing and future grants would be decreased by 25 percent. Currently, the Global Fund requires US$170 million to cover its 2008 programme commitments. The Fund further faces a US$ 4 billion shortfall in meeting its goals up to 2010. In an interview on April 20, 2009, Professor Michel Kazatchkine, head of the Global Fund, admitted that, “For the first time, the demand for funds in 2009 has exceeded the funds we have available.” He added that Round 10 funding will have to be suspended from 2010 to 2011 to replenish funds .
African countries negatively affected by the global economic crisis
Botswana's presidential spokesperson, Jeff Ramsay, recently announced that the country’s government will not be able to include new patients in its free ARV treatment programme from 2016 onwards, because it does not have sufficient funds to expand the programme. Botswana's government has warned that it may have to cut or completely withdraw its HIV and AIDS funding, despite the rising number of people needing treatment, as the global economic crisis takes a toll on the vitally important diamond-mining sector. The government is the main financier of the national HIV and AIDS response, contributing up to 80 percent of the budget, with donors making up the remainder. Lydia Mafhoko-Ditsa, the HIV and AIDS programme manager at the United Nations Development Programme (UNDP) in Botswana, has suggested that a potential solution to prevent a future funding shortfall might be to follow the example of Zimbabwe and Zambia: both countries have introduced an AIDS levy that channels a certain percentage of taxes into the national HIV and AIDS response.
In Malawi, delays in funding disbursements from the Global Fund have already caused worrying shortages in ARV supplies. As a result, ARV stocks are running dangerously low in several health facilities. In order to avoid further ruptures, the Ministry of Health, with the help of Médécins Sans Frontières (MSF) and other NGOs, is currently re-distributing ARV supplies to different districts. MSF has also had to buy additional backup stocks, to ensure a steady supply for patients in its projects. For now, MSF is able to start new patients on treatment, but there is a risk that this will have to slow down. On a positive note, however, the World Bank has pledged US$30 million to support Malawi in its fight against HIV and AIDS. The US has also confirmed that it will double its financial support to Malawi to US$45 million through PEPFAR.
In South Africa, the government budget for health has been substantially cut due to the financial crisis. This has seen a US$123 million shortfall in the country’s public sector ARV programme. Furthermore, large private firms, especially mining companies, are likely to cut their HIV and AIDS prevention programmes. This will affect thousands of employees and their families. The Treatment Action Campaign (TAC), one of South Africa’s main HIV/AIDS activist groups, which provides ARVs, counselling and HIV testing, was only able to secure US$7 million of the necessary US$8.1 million for its national programme. Consequently, it had to close down six of its provincial offices. This resulted from the decision by international donors to direct more funds to lower income countries and to focus more on strengthening health system programmes, thereby extending their focus to include other health issues in addition to HIV and AIDS. Severe ARV shortages have caused many clinics to stop enrolling patients into ARV programmes and the waiting lists are growing day by day.
Swaziland is the country with the highest HIV prevalence globally, with 26.1 percent of its adult population being HIV-positive. It is also largely dependent on external donors for funding of its ARV programmes. During the 5th IAS Conference on HIV Pathogenesis, Treatment and Prevention, which was held in Cape Town, South Africa in July 2009, the Swaziland government revealed that it had to lower its 2011 treatment coverage target from 60 to 50 percent because of dwindling support from external donors. NGOs in the country are also suffering as a result of funding cuts from various donors. Swaziland National Network of People Living with HIV/AIDS, an NGO that receives its funding from the Global Fund through the National Emergency Response Council on HIV and AIDS, had its budget reduced from US$130 000 in 2008 to US$100 000 in 2009. Another recipient of Global Fund support, The National TB Programme, has had its five-year budget of US$13 million reduced by 10 percent. On a positive note, however, PEPFAR has pledged US $30 million to the country’s fight against HIV and AIDS.
Approximately 96 percent of Uganda’s ARV programmes are funded by European and US donors. Of these, the two major contributors are the Global Fund and PEPFAR. An accredited Ugandan doctor, who was quoted in the media on condition of anonymity, has commented that the economic crisis has forced some donors to reduce funding, hence financially affecting local organisations that cater for people living with HIV and AIDS. Dr. Kihumuro Apuuli, the director general of the Uganda AIDS Commission (UAC), has also stated that the future may be quite bleak if the economic crisis continues, and has called for the creation of an HIV and AIDS ‘trust fund’. This comes amidst rumours that PEPFAR is considering withdrawing its funding to the country. Apuuli said: “We need to start a trust fund for HIV and AIDS in the country such that tomorrow, when Global Fund and Americans pull out, we can have a fallback position.”
Despite PEPFAR providing US$313.4 million in 2008 to the Tanzanian government, it had to cut its HIV and AIDS budget by 25 percent for the 2009-10 financial year. This will affect over 70 percent of people on ARV treatment in the next 12 months. Many organisations have commented that they have not received any funding since April 2009, hampering their HIV and AIDS, TB and malaria initiatives.
The way forward
Despite countries being adversely affected by reductions in donor funding, all is not lost, as there are numerous measures that can be implemented to mitigate the effects of the economic crisis. The report ‘The Global Economic Crisis and HIV Prevention and Treatment Programmes: Vulnerabilities and Impact’ makes various constructive suggestions to address the current financial turmoil.
It suggests that funding gaps and consequent treatment interruptions need to be addressed. In order to prevent treatment interruptions, countries with a high reliance on external funding should identify probable cash-flow interruptions and work with international partners to provide bridge financing. This can be can be done by implementing an early warning system by which treatment interruptions can be tracked, as well as devising a mechanism by which countries can have access to short-term emergency ARVs. ARV Access for Africa (AA4A) is an example of an organisation that provides emergency ARVs which it can mobilise within 24 hours and can reach 80 percent of sub-Saharan Africa destinations within one week.
One of the most important recommendations that the report makes is to strengthen programme efficiency and cost-effectiveness. This entails countries having to closely scrutinise their HIV and AIDS programmes and identify where efficiency gains and/or savings could be made. Where budget cuts are unavoidable, countries need to identify areas where funding cuts would have the least impact. A report summarising the findings of the 5th Meeting of the UNAIDS Programme Coordinating Board, also recommended that countries should seek greater efficiencies in existing programmes, by lowering the costs of inputs and reducing waste and avoiding duplication in funding support to programmes. The recent increase in the availability of generic ARV medication can do a great deal to lesson financial burden of patented ARV medication. Furthermore, countries should focus on evidence-based, result-driven programmes, instead of spending money on ineffective and inefficient interventions. Urgent attention should also be given to curbing the rampant misappropriation of donor funds. Countries such as Zambia, Mauritania and Uganda have seen donors withholding support as a result of misappropriation of funds.
The UNAIDS and the World Bank report also highlights the importance of not neglecting complementary inputs and interventions. This refers to maintaining funding for other critical areas such as salaries, drugs to treat opportunistic infections, STIs and TB. It should also be acknowledged that if well implemented, legal and social programmes that reduce stigma and discrimination represent good value for money. PEPFAR’s new broader approach, which includes implementing policies and practices to optimise effectiveness of resources in key areas, such as health workforce expansion, gender equity, protection of the rights of orphans, and effective HIV and AIDS counselling and testing is a good example of how this can be realised.
- Hilda Hecker is a Research Analyst in the HIV & AIDS Unit at Consultancy Africa Intelligence firstname.lastname@example.org.
- Ugandan civil society organisations have warned against criminalising the transmission of HIV/AIDS.
Action Aid Uganda’s Stella Mukasa, notes that, “Criminalising the transmission of the disease invokes stigma, discrimination and deters voluntary testing and access to treatment.”
Mukasa argues that applying criminal law to HIV transmission could result in women being disproportionately prosecuted and increase domestic violence.
“Women often learn that they are HIV positive before their partners and most likely, they will be blamed for bringing it into the family,” explains Mukasa.
To read the article titled, “NGOs oppose criminalising HIV/AIDS transmission,” click here.Source:New Vision
- The United Nations AIDS Programme (UNAIDS) says South Africa has more people living with AIDS than any other country, but it also has a new government determined to end the crisis.
UNAIDS executive, Michel Sidibe, "If I am not in South Africa for World AIDS Day, I don't know where I should be."
Sidibe maintains that President Jacob Zuma is committed to making change happen, praising the Department of Health for moving quickly to distribute more AIDS drugs and for working with the UN to improve ways of using scarce resources.
To read the article titled, “SA committed to making change happen,” click here.Source:Mail&Guardian
- Press Release
1 December 2009
United States Announces Additional $120 Million for ARVs in South Africa Pretoria
At the South African Government’s National World AIDS Day 2009 commemoration at the Pretoria Showgrounds today, Ambassador Donald H. Gips will announce that the United States will provide an addition $120 million (approximately R900 million) over two years for anti-retroviral (ARV) drugs. This one-time extra funding to procure ARVs will help ensure that there are adequate stocks on hand to meet the growing demand for ARVs in South Africa.
This funding is over and above the R4.2 billion budgeted for the regular U.S. government contribution to the fight against HIV/AIDS in South Africa (2010 fiscal year). It will assist the Department of Health and provincial governments to meet their goals for antiretroviral treatments and to help build capacity in the provinces for planning and forecasting ARV needs. The additional funding is in direct response to a request from President Jacob Zuma.
Through the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), the US has made the largest commitment in history by a single nation to combat a disease. The American people have provided more than US$25 billion to the fight against global AIDS. In South Africa, PEPFAR support from 2004-2009 has totaled over R10 billion.
“This additional funding is in direct response to the Government of South Africa’s request,” noted Ambassador Gips. “The United States has a remarkable relationship with South Africa in the fight against HIV/AIDs, and South Africa has made significant and real strides in testing and counseling citizens about receiving treatment. This funding provides a bridge to help individual South Africans gain access to ARVs. We are pleased and honored to respond to President Zuma as South Africa’s partner in this fight.”
For more information:
Date published:01/12/2009Organisation:United States Embassy, Pretoria
- US Embassy: Sharon Hudson-Dean, 012 431 4659 / 079 111 8276 / email@example.com
- US Embassy: Elizabeth Trudeau, 012 431 4217 / 079 111 8280 / firstname.lastname@example.org
- Pointing fingers at the administration of former president Thabo Mbeki is not helpful in dealing with South Africa's HIV/AIDS problems. This is according to Archbishop Desmond Tutu.
Tutu points out that, "I just think it's enough to say, we have had a disaster and ... how do we ensure that we don't repeat what we know happened."
Tutu’s comments follow renewed controversy in recent weeks over the HIV/AIDS policy pursued by Mbeki and his administration, which flirted with AIDS denialists, backed quack remedies and was markedly reluctant to roll out antiretroviral drugs.
"It was a bad policy, most people admit that ... Let's move on," says Tutu.
To read the article titled, “Let's move on, Tutu says of AIDS debate,” click here.Source:Mail&Guardian
- Rape victims should be encouraged to apply for compulsory HIV testing of alleged rapists. This is the view of Minister of Women, Children and Persons with Disabilities, Noluthando Mayende-Sibiya.
Mayende-Sibiya argues that rape survivors should fully utilise the provisions of the Sexual Offences Amendment Act, adding that they [survivors] have a right to request compulsory HIV testing of an alleged offender.
"We have to ensure that survivors know about this provision and are able to utilise it,” explains Mayende-Sibiya. She was speaking at an event to mark 16 Days of Activism Campaign on No Violence against Women and Children in Durban.
To read the article titled, “Rapist HIV tests compulsory,” click here.Source:News24
- The World Health Organisation (WHO) has urged countries to phase out the use of Stavudine, the most widespread anti-retroviral, because of what it calls long-term, irreversible side-effects in HIV patients, including wasting and a nerve disorder.
In sweeping changes to its guidelines, the WHO also recommends that people with HIV, including pregnant women, should start taking antiretroviral drugs earlier to live a longer and healthier life.
For the first time WHO advises HIV-positive women and their babies to take the drugs while breastfeeding to prevent mother-to-child transmission of the virus that causes AIDS.
Dr. Siobhan Crowley of WHO’s HIV/AIDS department, says that, “The new recommendations are based on a solid body of evidence indicating that rates of death, morbidity and HIV and tuberculosis transmissions are all reduced by starting treatment earlier. This prolongs and improves quality of life.”
To read the article titled, “WHO issues new recommendations for HIV patients,” click here.Source:Sowetan
- The South African Institute for Race Relations (SAIRR) has warned that South Africa’s slow response to the HIV/AIDS pandemic has triggered a time bomb that may leave one in three children orphaned.
SAIRR researcher, Gail Eddy, points out that while the country’s HIV-infection rate may have stabilised, “Estimates show that by 2015, some 5 700 000 or 32 percent of all children in South Africa would have lost one or both parents due to HIV/AIDS.
Eddy says that, "If the status quo is maintained, South Africa will be faced with a major crisis in the future, due to the social and economic consequences of increasing numbers of orphans and child-headed households."
To read the article titled, “SA faces major crisis over AIDS orphans,” click here.Source:Mail&Guardian
- Press Release
19 November 2009
Calls on South Africa and the media to focus on galvanising the nation around World AIDS Day 2009
In the past two weeks, both President Jacob Zuma and Health Minister Aaron Motsoaledi have committed to making the fight against AIDS a top government priority. In the National Council of Provinces (NCOP), President Zuma unequivocally acknowledged the devastation of AIDS. This has resulted in increasing mortality and a decline in the country's health. The President acknowledged that the fear, stigma and shame that have surrounded the epidemic must be overcome. He said all South Africans must feel secure to know their status, have access and adhere to treatment without fear of discrimination. He also explained that despite our efforts so far, “we are not yet winning this battle”.
Last week, the Minister of Health, Dr Aaron Motsoaledi, gave an unprecedented media briefing in which he too described, in detail, the devastation that AIDS has caused. He presented statistics showing how antenatal HIV prevalence rose from less than 1% in 1990 to about 30% in recent years. He showed how our life-expectancy is now lower than that of Senegal and Algeria, and the abnormal age distribution of death, in which most adults who are dying are between the ages of 25 and 39. He also told how recorded TB deaths have risen three-fold in the last decade. This was a comprehensive and accurate description of the HIV epidemic in South Africa. One of the minister's slides presented mortality data. It appears there was an error in the 2008 mortality figure received from the Home Affairs registry.
We are concerned about the subsequent media controversy over this figure. If there is a mistake, it does not detract from the message that deaths have increased terribly. It does not undermine the legitimacy of the other data presented by the Minister which comes from a range of independent sources.
We appeal to the media not to sow unnecessary confusion at a time when we need common purpose and understanding about the magnitude of the AIDS challenge. SANAC, and indeed the government as a whole, acknowledge the importance of having better and more accurate statistics about HIV and AIDS.
SANAC is aware that the Department of Health is taking steps to improve data, especially with regards to the number of people on treatment. The error is being investigated. But, leaving aside the 2008 figure, what is important to appreciate is that, since 1997, deaths have risen dramatically. Recorded deaths have increased over 90% in a decade. The median age of recorded deaths has dropped from 51 in 1997 to 44 in 2007. The vast majority of additional deaths are due to the HIV epidemic. President Zuma and Minister Motsoaledi are providing leadership to galvanise Parliament, government, civil society and business, in fact all in South Africa, to renew our response to the HIV epidemic. The President and Minister of Health are encouraging more people to test for HIV, improving the prevention of mother-to-child HIV transmission and scaling up of the antiretroviral treatment programme so that we can meet the targets of the HIV & AIDS Strategic Plan 2007-2011 (NSP). President Zuma and Minister Motsoaledi have defined the problem and what needs to be done to alleviate it. We appeal to all: Let us work together in a renewed commitment against the HIV epidemic.
Issued by Mark Heywood SANAC Deputy Chairperson on behalf of SANAC civil society sectors Contact: 083 634 8806Date published:19/11/2009Organisation:South African National AIDS Council
- Delta State Action Committee on AIDS (DELSACA) will disburse N36 million to 12 NGOs in Delta as grant for fight against HIV.
DELSACA project coordinator, John Osuyali, says that more than 140 NGOs applied for the second trench of the grant to carry out HIV related activities in the state.
"We have about N36 million for NGOs to carry out HIV related activities and only 12 NGOs will be eligible for the funding," explains Osuyali.
To read the article titled, “12 NGOs to receive N36 million grant to fight HIV in Delta,” click here.Source:All Africa