Budgeting for HIV: Let's not forget what hangs in the balance

This past week has definitely had us pulling out our calculators and knotting our eyebrows as we tried to scrutinise the numbers, analyse the figures, and work out what the increases and decreases (and haircuts) of the 2012 national budget will mean for our own pockets.

Ofcourse, I being the medic that I am (and unable to understand most of anything else), had my ears pricked up for the part where they’d speak about health.

I was glad that we were still on the top of the agenda and that HIV got a special mention (at a time when HIV is no longer fashionable to speak about, and only makes the papers when a celebrity decides to stop taking their ARVs, its becoming less and less predictable whether it will make an appearance or not).

We’ve done well.

It’s been just over 30 years since HIV was first discovered in five Los Angeles men, and although we got off to a bit of a fumbling start we’ve made some amazing strides. Globally the incidence of HIV and Aids-related deaths are lower than they have ever been, South Africa has dropped its incidence of people with new infections by a third since 2001, young people are engaging in less risky behaviour, male (and female) condom usage has increased, more men are signing up for the snip of the foreskin that could save their lives, our proudly South African scientists are producing some of the world’s most cutting edge research, and the use of ARVs in pregnant women and the many HIV-free babies as a result thereof have some of us starting to believe that we might actually beat this thing a lot sooner than we thought.

The world has never come together as it has to fight HIV. Before HIV it was seldom that we would see leaders of nations meeting to discuss a “soft issue” such as a health issue, and no development matter has raised the kind of money that HIV has. Despite its evils, HIV has come to represent a lot of goodwill. It has represented the fight for basic human rights, the fight for gender quality, the fight against discrimination and the fight against poverty. Our response to HIV, perhaps the greatest threat of our time, has been a triumph of humanity, like no other.

We’ve done well.

But:

HIV is increasingly starting to represent something else, a little more concerning: Africa’s dependence on the West. According to UNAIDS two thirds of Aids expenditure in Africa comes from external sources. And for some countries, such as Mozambique, DRC, Nigeria and Kenya, over 80% of their HIV programs are funded by international sources (UNAIDS). Although South Africa’s response has been chiefly funded by our government, a significant proportion of it is also completely dependent on donor funding. According to the South African 2010 country progress report, South Africa to date has received 291 million US dollars from the Global Fund to fight Aids, Tuberculosis and Malaria. Furthermore the United States Presidents Emergency Plan for Aids Relief (PEPFAR) supports 300 HIV/Aids organisations in the country and has helped the South African government initiate over 600 000 people on ARVs. According to the PEPFAR website 17 million South Africans have been assisted by PEPFAR funding of a total value of over R25-billion. A study conducted by Youde noted that South Africa is amongst the top four of PEPFAR funds per HIV positive person, and perhaps rightly so because we are home to the lion’s share of HIV positive people, an estimated 5.6 million people. But what do we do when the kind donors decide to use their money on something else? In 2009 we saw donors start to reduce the amounts they usually give and at the end of 2011 the Global Fund, one of HIV’s largest funders, announced that they would cancel new funding until 2014. Just last month local NGOs warned that delayed and unpredictable payments jeopardised the success of their efforts. UNAIDS estimates that 12 billion US dollars annually will be needed by 2015 to prevent new HIV infections and to scale up the response in Africa, but the impact of the economic crises on foreign aid is real and frightening.

With studies now showing that ARVs not only save the lives of those taking them but prevent those infected from passing the virus to others, we really cannot afford to gamble. We have more people alive in South Africa with HIV than we ever have, and that is because of the success of our ARV enrollment programs. Our country boasts the world’s largest ARV program and that should be celebrated. But what this means is that the numbers of those reliant on ARVs will rise and so will the costs, and we certainly cannot bank on the altruism of countries, now facing their own financial difficulties, to meet those needs.

One seldom can say for sure what motivates the decisions made in the offices and boardrooms of the world’s heavyweights and most of us are unlikely to ever be able to influence those decisions. But almost all of us in this country have a vested interest in fighting this disease to the very end and almost all of us know someone who is infected with this disease, if we are not infected ourselves. So who else, but us should be most motivated to come up with innovative and sustainable solutions for combating HIV? As Michel Sidibé, Executive Director of UNAIDS puts it, we need to come together as a continent and “forge solutions for Africa, by Africa”, if we really want to beat this thing.