Treatment rationing in low-income countries on the rise, will worsen, warn advocates

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Rationing of antiretroviral treatment in low and middle-income countries is on the rise, and if international donors persist in attempts to cap future support for the Global Fund to Fight AIDS, TB and Malaria below current levels, rationing is likely to become widespread, advocacy organisations say.

In its report Rationing Funds, Risking Lives: World Backtracks on HIV Treatment, the International Treatment Preparedness Coalition highlights the effects of flatlining of HIV treatment funding by the United States government and the Global Fund on treatment initiation in six countries.

The country facing the most severe problems is Uganda, where rationing is already becoming evident.


middle income countries

The World Bank classifies countries according to their income: low, lower-middle, upper-middle and high. There are around 50 lower-middle income countries (mostly in Africa and Asia) and around 60 upper-middle income countries (in Africa, Eastern Europe, Asia, Latin America and the Caribbean).


A serious disease caused by a parasite that commonly infects a certain type of mosquito which feeds on humans. People who get malaria are typically very sick with high fevers, shaking chills, and flu-like illness. 

low income countries

The World Bank classifies countries according to their income: low, lower-middle, upper-middle and high. While the majority of the approximately 30 countries that are ranked as low income are in sub-Saharan Africa, many African countries including Kenya, Nigeria, South Africa and Zambia are in the middle-income brackets. 

"In my home country, Uganda, for the first time since 2004, some HIV-positive men and women who are in need of life-saving antiretroviral treatment are being turned away because of funding cuts. Our greatest fear is that we may have to ration HIV medications for those already receiving treatment. How do you tell an HIV-positive mother that she can no longer have the drugs she needs to stay alive? ITPC’s report makes it painfully clear that Uganda is not alone in facing an escalating treatment crisis," said Dr Peter Mugyenyi of the Joint Clinical Research Centre in Uganda.

Asia Russell, director of international policy for Health GAP, who visited Uganda recently to review the impact of treatment rationing, last week described how patients are being turned away from clinics, testing curtailed and cheaper, more toxic drugs are being reintroduced as a result of limits on US funding.

The IRPC report also examines case studies of restricted treatment access due to funding shortages in India, Kenya, Latvia, Malawi, Swaziland and Venezuela, illustrating the wide spectrum of problems being experienced in both low and middle-income countries (Latvia is a member of the European Union) as a result of diminishing funds from donors and national governments.

Donors gathered at the Global Fund’s quarterly board meeting are alleged to be promoting the idea of a cap on Global Fund grants in the period 2011 t0 2013 that would permit no further expansion of numbers on treatment.

At the same time donors are also considering a proposal to expand the mandate of the Fund to cover maternal and child health too. Unless adequately funded, this could further dilute the funds available for HIV treatment.

US-based advocates called on the US government not to support a cap on treatment funding.

“An artificial cap on funding would gravely undermine the Global Fund’s innovative demand-driven model, which matches donor resources with developing countries’ ambition in expanding access to life-saving health services,” said said Dr Paul Zeitz, executive director of the Global AIDS Alliance. “The United States must step back from the brink of this decision and recommit to fully funding the fight against AIDS, TB and malaria.”

"It is outrageous that the Obama administration has used trillions in US taxpayer money for Wall Street bailouts, allowing bankers to give $20 billion in bonuses, while donors come to this meeting intent to impose a cap on the number of people who will get life saving AIDS treatment and planning to break their promises to fully fund the Global Fund," said Asia Russell, director of international policy at Health GAP.