Up to 1.7 million people in Africa, Eastern Europe, the Caribbean and Asia are at risk of antiretroviral treatment interruption due to the global financial downturn, according to a survey published by the World Bank.
The World Bank report Averting a human crisis during the global downturn (pdf available here) was published in advance of the World Bank’s spring meeting in Washington DC. It states unequivocally: “The international community is obligated to continue to support the people it has placed on ART…The international community has made an unambiguous commitment towards universal access to treatment for people with HIV who need it.”
Failure to meet this commitment, the report notes, will call into question the legitimacy of development assistance for health, threaten the gains in health system capacity delivered through HIV treatment programmes and will ultimately result in greater long-term costs due to higher rates of transmission, more TB cases and larger numbers requiring expensive second-line drugs for both HIV and TB.
The World Bank questioned national AIDS programmes in 69 countries in March 2009.
The World Bank calculated that continuity of treatment could be threatened for around 70% of people currently on treatment in eastern and southern Africa. Around 50% in the Asia-Pacific region, 35% in the Caribbean and 25% in Eastern Europe and Central Asia could be affected too.
The report notes the fragility of financing arrangements for countries largely dependent on external aid for their HIV programmes. Eighteen of 47 countries that provided data said that grants from the Global Fund to Fight AIDS, TB and Malaria end in 2009 or 2010. The Global Fund faces a funding shortfall of $4 billion in 2010, director Professor Michel Kazatchkine said last week. The Global Fund has postponed its Round 9 funding allocations until November 2009 in order to allow more time to mobilise funding.
Middle-income countries appear less vulnerable, with no countries in Latin America anticipating a reduced ability to pay for antiretroviral treatment during the next year.
Analysing the institutional capacity to make rapid adjustments in financial planning and the fiscal capacity to move domestic funds into treatment at short notice, the World Bank found that all countries would need either a high level of technical support or maintenance of external financing in order to sustain treatment programmes during the next 12 months.
The report emphasises the cost of even minor treatment interruptions: up to 50% of people taking first-line treatment may need a second-line regimen if their treatment is interrupted for more than 15 days, due to the development of drug resistance.
The report also highlights the vulnerability of eastern and southern Africa treatment programmes that are largely dependent on donor aid. Some countries are already experiencing problems:
- Tanzania has cut its HIV/AIDS budget by 25%;
- Kenya has reduced its overall health budget;
- South Africa anticipates that private sector spending on prevention programmes will decline due to pressure on industry to cut costs.
Thirty-four countries representing 75% of people living with HIV said that they expected prevention programmes to be negatively affected, and national AIDS programmes anticipated greater impact on prevention than treatment, with prevention targeting marginalised groups such as men who have sex with men and injecting drug users at greatest risk, according to respondents. Eastern Europe and Central Asia was identified as the region where prevention work with marginalised groups is at greatest risk due to the economic downturn.
The report recommends “a more rigorous and determined push for efficiency and cost-effectiveness in HIV prevention”, together with efforts by donors to identify cash flow problems that might result in treatment interruptions, so that bridging funds can be provided as quickly as possible.
UNAIDS has begun developing an Economic Crisis Impact Assessment Tool that will assist countries in reviewing their epidemics and current responses, and how responses should be revised in the face of the economic crisis.