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HEALTH: Money Needed for ART Funding

Louise Redvers

JOHANNESBURG, May 23 2011 (IPS) - Fixed targets for universal access to AIDS treatment and funding to make it achievable are what HIV and AIDS organisations want from the upcoming United Nations General Assembly Special Session due to be held in New York next month.

Due to be held in early June and attended by international policy makers and heads of state, this meeting will shape the direction of the global response to HIV and AIDS for the next decade and beyond.

The 2006 Special Session of the General Assembly (UNGASS) and subsequent creation of the Global Fund grant distribution body were instrumental in mobilising funding for the expansion of antiretroviral treatment (ART) programmes, which now reach roughly five million people.

But campaigners stress that this momentum must be maintained to avoid undermining progress made so far in the fight against the disease and funding shortfalls need to be addressed.

Anton Kerr, head of policy at International HIV/AIDS Alliance, said: “We are at a pivotal moment in terms of deciding what the commitment will be going forward.

“HIV has been slipping off the political agenda and you’ve also had the financial crisis, so its crucial that UNGASS secures that high level political will that will unlock money and commitment in the years to come.

“Without political commitment, there is no obligation for governments and donors to act and there will be serious long-term impacts from these decisions.”

In a bid to secure funding and political commitment, groups like International HIV/AIDS Alliance want to underline the benefits of ART as not just a treatment method but also as a tool to reduce transmission.

An United States National Institutes of Health reports revealed in May that if an HIV-positive person adheres to an effective antiretroviral therapy regimen, the risk of transmitting the virus to their uninfected sexual partner can be reduced by 96 percent.

This backs up a similar study published in the United Kingdom’s health journal The Lancet in late 2010 and UNAIDS has suggested that scaling up joint treatment and prevention strategies could cut new infections by half.

“Increased access to ART has not only saved millions of lives, it has also cut the transmission rate,” explained Mara Kardas-Nelson, an access and innovation officer with Médecins Sans Frontières (MSF).

She added: “If people get onto ART early it has a community-wide impact, it’s not just an individual gain.

“People on ART are also living healthier lifestyles so the associated healthcare costs are reduced in terms of hospital time and other medicines, and they are living longer and are able to be more economically active.”

Kardas-Nelson said it was understandable that there had been a drop in support for international causes following the global financial crisis and increased domestic spending pressures.

But she urged donors to look at ART funding as an investment that would pay off in the longer term.

“ART is proven to reduce new infections so this will reduce treatment needs in the long term,” she said. “Money that is invested now will save money in the longer term.”

Finding that money though may not be so easy. Following unfilled pledges from its donors the Global Fund suspended grant allocations during 2011 and applicants who were refused money in 2010 could have to wait until 2013 to receive any cash.

The impact of a lack funding for ART programmes was one topic discussed in the MSF report “Getting Ahead of the Wave” published in May.

Looking at 16 countries in Africa, Asia and Latin America that account for 52 percent of the global AIDS burden, MSF evaluated the impact ART had in those countries and other developments in HIV and AIDS responses.

It found that greater access to ART had reduced HIV-related deaths, lowered infection and deaths of tuberculosis and greatly lowered healthcare costs as people were spending less time in hospital and needed fewer supplementary medicines.

In the Cape Town township of Khayelitsha, where an estimated 16 percent of the adult population of 500,000 is HIV-positive, ART was first provided in 2001 and the study notes that as ART provision increased, so new infections fell.

The study warned, however, that while 12 of the 16 countries evaluated had changed treatment protocols to get people onto ART earlier and 14 had adopted better-tolerated medicines, several, including Malawi and Zimbabwe were struggling under financial constraints.

It also noted that in most of the countries it studied still only around half of people in need of ART drugs were getting them.

MSF concluded that progress in the fight against HIV/ AIDS while positive in many aspects still remained “volatile” if ART strategies could not be sustained in the long term.

U.N. Secretary-General Ban Ki-Moon has called for a target of at least 13 million people to be receiving treatment by 2015, others, including the International HIV/AIDS Alliance, want 15 million, which they say will still offer 80 percent coverage.

Kerr stressed that all targets must also be accompanied by clear measurement indicators to allow detailed tracking and progress analysis.

He added that more effort was needed to create more innovative financing models, and build on existing schemes such as patent pools, which were working to reduce the cost of medicines.

The MSF study did note that there had been great strides in the past decade in terms of reducing drug bills and widening access.

It reports that competition from generic manufacturers has driven the price of the most-commonly- used antiretroviral combination down from more than 10,000 dollars per patient per year to 67 dollars today – a decrease of 99 percent.

Another important step forward has been the introduction of simpler diagnostic tests which can be used in remote areas without electricity and by minimally-trained health workers.

MSF’s Kardas-Nelson said medical innovation was crucial to continuing to reduce costs and increasing accessibility.

“We need innovative diagnostic tools, innovative ways to getting treatment to people and innovative new medicines,” she explained.

“Innovation goes hand-in-hand with increasing access to treatment,” she added.

Despite the advances noted by the MSF report over the last decade, some 10 million people still need ART treatment.

Tido von Schoen-Angerer, executive director of MSF’s Access Campaign, said it was crucial that June’s UNGASS delivered.

He said: “With the right policies in place, we could triple the number of people on treatment without tripling the costs.

“But if key donor governments don’t support a treatment target, they are sending a clear message that they do not intend to ever come to grips with this pandemic.”

The U.N. General Assembly Special Session, which some believe may be the last of its kind to be held, takes place in New York June 8 – 10.