We Can End Aids, But We Cant Do It Alone

We Can End Aids, But We Cant Do It Alone
  • PublishedJuly 20, 2012

With the International AIDS Conference just days away and the 19th African Union Summit having concluded this week, the discourse around ending the HIV/AIDS epidemic progressively shifts towards the role of African leaders in fighting the disease. As UNAIDS Executive Director Michel Sidibé recently stipulated: Africa needs to ‘own its epidemic.’ This can only go so far, says Dr Frank Chimbwandira, Director of the HIV/AIDS Department of the Ministry of Health in Malawi, in this special guest column. Malawi, like many other African countries is implementing ambitious plans to scale up treatment and improve protocols, but has serious concerns about the future of its national programme. Like many of its neighbouring countries, Malawi is facing a severe funding gap and its people living with HIV/AIDS are confronted with an uncertain future.

Thirty years after the first case of HIV, the epidemic continues to devastate many countries, especially within the Southern Africa region. With 34 million people currently infected with the virus and 1.8 million people dying of AIDS in 2010, communities continue to be stripped of mothers, fathers, sisters, and brothers. Walking through rural villages, there are few, if any, households that have not been touched by the epidemic.

But now there is hope. Last year brought landmark scientific evidence that we already have the tools we need to halt and reverse the epidemic. A study showed that HIV treatment not only saves lives, but it reduces by 96% the likelihood of the virus being passed to others. Rather than waiting for a vaccine, the treatment we already have, along with other prevention efforts, can stop the epidemic in its tracks.

In light of this evidence that HIV treatment is also prevention, UNAIDS and others have demonstrated that if we substantially scale-up HIV treatment now, more than seven million deaths and twelve million new infections can be averted by 2020. According to researchers, the societal benefits of accelerating HIV treatment almost entirely offset the costs within ten years.

In Malawi we are committed to implementing programmes based on this promising new science. We want to extend treatment to as many people who need it as quickly as possible, so that we can save lives and prevent new infections. As reported in UNAIDS annual progress report, there has been a tremendous increase in treatment coverage: today, 8 million people are on antiretroviral treatment worldwide. In Malawi, we had 347,983 people on ART by the end of March, presenting a tremendous scale-up in the past few years.

We want to start people on HIV treatment early, before they are sick and vulnerable to other infections such as tuberculosis, however our laboratory infrastructure is not yet adequate to ensure people receive a CD4 count to identify their stage of their illness. We want to provide people with well-tolerated drugs that help them stick to their treatment, but due to funding shortages had to provide these improved drugs to a selected group of patients only (pregnant women, those with TB/HIV co-infection and side-effects). We want to provide HIV positive expectant mothers with timely and improved treatment regimens for life to reduce the risk of transmission to their infants while ensuring that both mothers and their babies have the best chance to be healthy. As the first country in Africa, we have started to do so last year.

Yet just as success is within reach, we are up against a great financial squeeze. For three years in a row, global spending on HIV/AIDS has been on the decline. For the first time since the Global Fund to Fight

AIDS, Tuberculosis and Malaria (GF) opened its doors in 2002, it had to cancel a funding round in 2011 and our proposal in Round 10 that included scale-up on all areas was rejected as deemed too ambitious. The funding shortage could spell devastation for countries that rely on these monies. The current GF grant paying for ARVs for the nearly 350,000 people in Malawi on treatment to date will run out in early 2014. A new budget of approximately $500 million USD for the following five years will be needed just for ARVs to avoid interruption of treatment to the by then anticipated 450,000 to 500,000 people on treatment. There is a lot at stake.

While we intend to take on a larger role in paying for our national HIV programmes – and we have already taken steps to do so as reflected in our financial commitments towards health and/or HIV agreements– we also must face the reality that Malawi, like several other countries in Southern Africa most heavily impacted by HIV, is among the poorest countries in the world. While we can do more with our own budgets, we cannot tackle the epidemic without help from international funding to do this. A recent study on Malawi concluded that even if Malawi implemented a combination of all new strategies to source alternative funding, including an airline and telecommunication levy, it would only cover only 17% of the estimated HIV funding gap projected for 2020/21.By then, the gap is estimated to have reached $348 million USD, which would translate into to 4.5% of GDP or 16.4% of Government expenditure for that year (Sustainable Financing for HIV/AIDS in Malawi, Oxford Policy Management, March 2012).

Limited funding means our national programmes cannot act on the new science that will be discussed at the upcoming International AIDS Conference in Washington and that UNAIDS and others are promoting. Worse, in some cases, countries like us are not only restricted in what we can do, but potentially have to scale-back on recent gains. Funding shortages not only threaten to cap the number of new people receiving treatment, but also threaten the continuity of treatment for those who already receive it. It is simply tragic that at a time when we have more tools and evidence than ever to reverse the HIV epidemic, the funds are completely inadequate.

Science shows us what we can achieve and we are ready to implement this in our country. As President Obama referred to in his speech on last World AIDS day, we are ready to step up and be a part of this sustained commitment to create an AIDS-free generation, in concert with other governments, civil society, scientists, and policy makers.

I truly believe that we can end AIDS. But we can’t do it alone.


Dr Frank M Chimbwandira is the Director of HIV and AIDS at the Malawian Ministry of Health

Written By
New African

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