LONDON (AlertNet) - The mood at the international conference on AIDS that kicks off in Vienna on Sunday - gathering some 25,000 policy makers, activists, researchers and journalists - is expected to be relatively upbeat, thanks to the rising number of people accessing life-saving HIV treatment. But not everyone is optimistic about the future.
Esther Goba, a Malawian nurse who works with medical aid group Medecins Sans Frontieres (MSF), is worried about the prospect of reduced international funding to tackle HIV/AIDS in poor countries like hers.
MSF says budget choices by rich countries that are freezing or cutting overseas aid for HIV treatment programmes are already putting lives at risk.
Goba, HIV-positive herself, is concerned about her family's future if she is no longer able to get the antiretroviral (ARV) drugs she needs to keep her healthy.
"I was so afraid (when I heard this could happen). Who will look after my children? I am a widow. Who will support them, so they can go to school?" she told reporters in a telephone briefing this week.
"If donors say they would like to peak (their funding) now, it will be a very big challenge in Malawi and in the whole of Africa. People will suffer a lot...there will be a lot more dead and more orphans," she said.
Goba explained that before widespread antiretroviral treatment (ART) began in Malawi, HIV-positive medical staff were unable to do their jobs properly and hospitals were overloaded with patients.
"Before I started ARV, I was always sick - I often couldn't go to work," she said. "Now I can go to work, and it has contributed a lot to the country, because I am not the only one."
Curbs on treating HIV patients would have a negative impact on the development of the southern African country because people would be spending more time off sick, caring for orphans and ill relatives, and going to funerals, she added.
At the AIDS conference, MSF will present data from Thyolo, a rural district of Malawi, where it works with the government to provide HIV services at the primary health care level, enabling at least eight out of ten people in need to receive ART.
Between 2000 and 2007, there was a 37 percent reduction in the district's death rate, measured through death registers, coffin sales and church funerals, and an estimated 10,156 deaths were averted over an eight-year period.
But the medical charity says that, in some countries, flat or decreased funding is starting to translate into fewer treatment slots for a rising number of people in need.
"Clinicians and nurses in some instances are faced with the agonising decision that comes with rationing care: choosing who gets to live and who doesn't," it said in a report published ahead the conference, setting out "the 10 consequences of AIDS treatment delayed, deferred, or denied".
As an example of what MSF is witnessing in several countries across sub-Saharan Africa, it cites Uganda, where it says organisations implementing the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) have received a letter stating there will be no funding increases and new patients should only be enrolled on ART if others in the treatment programme die or drop out.
Statistics on PEPFAR's website show the rate of increase in its funding has slowed significantly since 2009, creeping up only slightly to reach $6.8 billion in 2010. For 2011, the president has made a budget request of nearly $7 billion.
MORE CASH NEEDED FOR EARLIER TREATMENT
At the same time, MSF says new guidelines from the World Health Organisation to initiate treatment at an earlier stage of AIDS in poorer countries mean more people - 14 million instead of 10 million Â? are eligible for treatment.
Only around 5 million receive it now, despite an international promise made in 2006 to provide universal access by the end of this year.
"Addressing the 10 million-person treatment gap will demand vastly increased resources for ART scale-up," the report says.
Meanwhile, MSF notes there have been a growing number of disruptions to ARV supplies in sub-Saharan Africa since last year. In 2009 and 2010, it has had to provide emergency supplies to public clinics in Mozambique, Malawi, Uganda and Democratic Republic of Congo, which previously relied on international donors, it says.
Lower or flat levels of funding from rich countries aren't just a result of the global financial crisis, according to the group. Even before governments started bailing out banks hit by loan problems a couple of years ago, squeezing their budgets, they had begun shifting aid towards improving the health of mothers and children and support for general health systems.
But in MSF's view, this is a zero-sum game, because so many maternal and child deaths are attributable to AIDS, and without healthy medical staff, health systems can't function properly.
The charity is also lobbying for the use of less toxic but more expensive ARVs in poorer countries. "With the extra cost, donors are also buying extra quality," said Helen Bygrave, an HIV/AIDS doctor for MSF South Africa. "We hope these drugs will become more cost-effective."
In the tiny country of Lesotho - an enclave entirely surrounded by South Africa - patients had to walk three to four hours up and down mountains to access treatment in hospitals before a programme to decentralise ART to clinic level, use better medicines, and tackle tuberculosis - a common co-infection - at the same time. Or they just stayed at home and got sicker, Bygrave said.
"(The programme) has had a huge effect, with a decrease in mortality and the number of people going into hospital," she said. "We can no longer justify the double standards of care between resource-rich and resource-poor countries."
For more information on MSF's work with HIV/AIDS, visit the organisation's conference website.
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