By Marielle Bemelmans
After decades of struggle against HIV, there is still an urgent need to do more to stop needless deaths. Despite effective and largely affordable drugs, tools and models of care, 1.7 million die annually from Aids-related illnesses. This is unacceptable.
Earlier this week, the European Commission hosted a Brussels meeting to discuss the next replenishment of the Global Fund to Fight Aids, Tuberculosis and Malaria at which the fund, the main funding mechanism to support the response to the three diseases, will ask donors for its next three-year trench of money. At this meeting, the Global Fund announced that it would need about R134 billion over the next three years to address HIV, TB and malaria.
As the host of the meeting, the European Union must be a true champion of the fight against HIV and Aids, and push the Global Fund to be ambitious both treatment scale up and retaining people in care.
On the ground, MSF is seeing worrying signs that ambition might not translate into reality.
In the Democratic Republic of Congo (DRC), only 12% of people who need antiretrovirals get them, leaving 386 000 in desperate need of the drugs.
DRC is one of the low-income countries the Global Fund said it would prioritise in the early implementation of its new funding model. But in practice, as needs in DRC continue to grow, the money to be allocated to the fight against HIV by the Global Fund in the country for the next three years will be lower than that given to the country in the last three years.
Another critical example relates to the lack of qualified medical staff. In countries such as Malawi and Mozambique, health systems operate with less than a fifth of international minimum staffing norms.
This pressure on frail health systems remains a critical issue in the delivery of care including HIV treatment. MSF has shown that models based on community groups and patients themselves could work very well through a decentralised approach when supported by community health workers and counsellors. Despite the good results obtained with those approaches, replication remains difficult as governments often struggle, or are unable to absorb and pay for these indispensable staff.
The Global Fund has been one of the few sources of financial support for these activities but it is gradually scaling down funding for staff in countries like Lesotho and Zimbabwe. The EU should use its leverage as a major global fund donor to ensure that community-based approaches will continue to be supported. We also call upon the EU to include these community approaches in its own health programmes.
Our experience in resource-poor settings has shown that community models represent a strong approach to achieve a massive scale up of people on treatment and provide critical support for treatment adherence. The United Nations goal to put 15 million people on treatment by 2015 will remain a distant dream if we expect weak health systems to take care of the seven million people still to be enrolled.
This can only be achieved through unprecedented commitment by all donors in this period of replenishment. In more than 20 countries, MSF teams work alongside health professionals, community members and patients who are dedicated to fighting HIV and Aids day in day out, but they need to be given the means to do that.
To have the slightest chance of making these targets a reality and to save millions of lives we need the EU to use this opportunity to demonstrate its leadership on HIV and Aids, human resources for health and in international health. Until this happens, people will continue to die unnecessarily.
MSF currently provides HIV treatment to 220 000 people in 23 countries.
Marielle Bemelmans is MSF’s HIV and Aids policy adviser.