© Brendan Bannon
HIV/AIDS is a lifelong disease, and although there is no cure, treatment with antiretroviral drugs (ARVs) prolongs and improves the quality of life. AIDS treatment in developing countries began roughly a decade ago, mostly as small pilot projects and in the face of widespread scepticism about its feasibility in resource-poor settings. MSF was one of the first organisations to provide antiretroviral therapy (ART) in developing countries, starting with projects in Thailand and South Africa in 2000.152
MSF is currently supporting care and treatment for more than 154,000 people in 27 countries. By the end of 2008, a total of four million people across the developing world were on ART.1
Delivering ART to millions of people in developing countries was made possible because treatment was brought close to where people lived, the price of medicines came down dramatically, and treatment was simplified and made more patient-friendly, with several medicines combined into one pill (known as a fixed-dose combination, or FDC). And in order to address the shortages of medical staff in many countries, tasks are being shifted, so that nurses or nurse aides can perform many of the duties previously reserved for doctors.
While these achievements represent important progress, the crisis is far from over. Until recently it was estimated that almost 10 million people are in immediate need of treatment, a testament to the persistent emergency.2 With the revision of the World Health Organization (WHO) guidelines in late 20099, which recommend, in line with current evidence, that treatment be initiated earlier in a patient’s disease progression, the number of patients in need of ART is expected by some to increase by a further five million to around 14 million people.3 The number of people who will need treatment by 2030 has been projected to reach as many as 55 million.4
At the same time, with growing numbers of patients in developing countries having been on treatment for five years or longer, new challenges are emerging to ensure their long-term survival. For treatment to be most successful, patients need to be monitored effectively and have access to newer and more potent drugs when they inevitably develop resistance or side effects to their medicines over time. But most newer drugs are unaffordable because of high monopolistic prices and crucial monitoring tests are not adapted for use in resource-poor settings.
‘ We’re at a fork in the road: either governments summon the political will and financial resources to treat AIDS in developing countries, or current funding for AIDS treatment stagnates, which means patients will see their treatment delayed, deferred and denied. It’s a question of choice: if they don’t help us treat AIDS, there will be more graves.’
-- Dr. Tido von Schoen-Angerer, Director of MSF’s Campaign for Access to Essential Medicines
However, the international AIDS effort is at a critical juncture, compromised further by the response of world leaders to the economic crisis: the two main funding sources for HIV/AIDS in developing countries, the Global Fund to Fight AIDS, Tuberculosis and Malaria and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), will not be able to support the treatment scale-up at its current rate given insufficient donor commitment. The Global Fund is facing a significant financing gap and PEPFAR’s funding levels are flat.187 Barely four years after world leaders met at the 2006 United Nations General Assembly and committed to universal access to HIV prevention, treatment and care, political and funding support is waning. Extending ARV treatment in developing countries to all people in need, while ensuring patients can survive with HIV in the long-term, will require much more investment and political will.