Global economic crisis threatens HIV prevention and treatment gains in poor countries (AEGiS.org) - Global economic crisis threatens HIV prevention and treatment gains in poor countries
UNAIDS - July 6, 2009
http://www.aegis.org/news/unaids/2009/UN090708.html

Geneva, July 6, 2009--In 22 countries in Africa, the Caribbean, Europe and Central Asia, and Asia and Pacific, disruption of HIV prevention and treatment programs is expected over the course of this year as a result of the global economic crisis, according to a new report from UNAIDS and the World Bank, released today.
According to the new report, 'The Global Economic Crisis and HIV Prevention and Treatment Programmes: Vulnerabilities and Impact'<http://data.unaids.org/pub/Report/2009/jc1704_econcrisis_hivresponse_en.pdf>, reports from agency staff in 71 countries indicate that eight countries are already facing shortages of antiretroviral drugs or other disruptions to AIDS treatment. Together, these countries are home to more than 60% of people worldwide receiving AIDS treatment.
HIV prevention programs are also in jeopardy. In 34 countries, representing 75% of people living with HIV, respondents say there is already an impact on HIV prevention programmes focusing on high-risk groups such as sex workers, people who inject drugs and men who have sex with men.
"This is a wake-up call which shows that many of our gains in HIV prevention and treatment could unravel because of the impact of the economic crisis," said Michel Sidibe, Executive Director of UNAIDS. "Any interruption or slowing down in funding would be a disaster for the 4 million people on treatment and the millions more currently being reached by HIV prevention programmes. We need to show solidarity with people living with and affected by HIV just as they are beginning to hope for a better future."
Antiretroviral treatment vulnerable
The joint report says that in some countries the affordability of antiretroviral treatment is affected by falling household income and wages and/or increased cost of antiretroviral drugs caused by exchange rate devaluation.
Furthermore, the report suggests that poor nutrition could also force people to stop their life-saving treatment because not eating enough of the right foods can impair the effectiveness of their drugs. Community networks, which are the only social safety net for the poor are also being crippled by the financial crisis to the point of collapse and some respondents report that the availability of antiretroviral treatment is being threatened by budget cuts.
Many respondents are concerned that the financial sustainability of antiretroviral treatment programmes that depend mainly on external aid is uncertain. There are no reports of substantial cuts in donor assistance for 2009, but respondents in nearly 40% of the surveyed countries report that the current funding commitments for treatment programmes will end in 2009 or 2010, and most fear that external assistance will not increase or even be maintained at current levels.
"This evidence shows us that people on AIDS treatment could be in danger of losing their place in the lifeboat and bleak prospects for millions more people who are waiting to start treatment," says Joy Phumaphi, the World Bank's Vice President for Human Development and a former Health Minister for Botswana. "We cannot afford a 'lost generation' of people as a result of this crisis. It is essential that developing countries and aid donors act now to protect and expand their spending on health, education and other basic social services, invest effectively and efficiently, and target these efforts to make sure they reach the poorest and most vulnerable groups."
HIV prevention efforts especially under threat
The report describes how respondents in 34 countries, where 75% of people with HIV live, expect prevention programmes for populations at higher risk to be affected. Respondents say that prevention efforts for populations at higher risk are especially vulnerable, because they are politically easier to cut. This is extremely worrisome--less prevention that results in more new infections will mean greater future treatment needs, with large cost implications.
Urgent measures needed
UN Secretary-General Ban Ki-moon has highlighted the economic crisis as a cause for global concern and underlined the importance of turning the economic crisis into an opportunity for a sustainable future. The UNAIDS/World Bank report outlines a number of urgent steps which are needed to maintain and expand access to HIV treatment and prevention during the global economic crisis and beyond.
Use existing funding better--especially in countries facing cuts in their national AIDS response budgets, governments and aid agencies should provide technical support to reallocate resources from low- to high-impact prevention and treatment programmes. All countries should seek ways to make programmes more efficient and more cost-effective.
Address urgent funding gaps--countries with a high reliance on external funding for HIV should strengthen collaboration between national authorities and major international funders to identify and address impending cash-flow interruptions and arrange bridge financing as necessary to avoid cash-flow interruptions.
Monitor risks of programme interruption--a simple warning system could be established to anticipate and minimize treatment interruptions. A key component of such a system would be to carry out regular surveys to identify "vulnerable" countries and provide tailor-made financial and policy assistance.
Plan for an uncertain environment--the uncertainty that many respondents note calls for contingency planning: contingency plans could consider changes that could be made to ensure continued access to treatment and realistic expansion plans, and to maintain the most effective, highest priority prevention activities under alternative potential funding scenarios. The report recommends that resource mobilization strategies include sources of finance that can be sustained over the long term.
To see more of the new report 'The Global Economic Crisis and HIV Prevention and Treatment Programmes: Vulnerabilities and Impact' visit http://www.unaids.org  
Resources:
Press centre:
Download printable version (pdf, 82.7 Kb.) - http://data.unaids.org/pub/PressRelease/2009/20090706_pr_unaids_wb_report_en.pdf  
Feature stories:
Global economic crisis and HIV (06 July 2009) - http://www.aegis.org/news/unaids/2009/UN090706.html  
Contact:
UNAIDS: Sophie Barton-Knott
Tel. +41 22 791 1697
E-mail: bartonknotts@unaids.org  
World Bank Washington
Phil Hay
Tel. +1 202 473 1796
E-mail: phay@worldbank.org  
Publications:
The Global Economic Crisis and HIV Prevention and Treatment Programmes: Vulnerabilities and Impact (pdf. 1,09 Mb.) - http://data.unaids.org/pub/Report/2009/jc1704_econcrisis_hivresponse_en.pdf   
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Global economic crisis and HIV
UNAIDS - 6 July 2009
http://www.aegis.org/news/unaids/2009/UN090706.html

A joint Word Bank/UNAIDS report looks at the potential impact of the global financial crisis on HIV prevention and treatment programmes worldwide. Using data collected in March 2009 from 71 countries, the analysis looks at how the crisis could affect the nearly 4 million people living with HIV on treatment, and the 7 million who need treatment but don't have access to it, and proposes some appropriate responses. The potential effects on prevention activities were also investigated. The report suggests that the well-being of millions of people could be put at risk.
The financial crisis started in the most-developed economies, but its impact has been felt in virtually all nations, leading to fears that donor assistance will remain flat or be cut, the budgetary revenues of developing countries will fall and worker remittances will decline. Many households may experience increased mortality and morbidity if the commitments made by the international community to sustain and increase access to antiretroviral treatment are not honoured and/or government expenditures on AIDS are reduced.
The report notes that an important lesson learned during previous crises is that cuts in core social development spending have long-term negative effects. Responding to fiscal pressures by reducing spending on HIV will reverse recent gains and require high-cost offsetting measures over the longer term.
Treatment at risk
At present, nearly 4 million people are on antiretroviral treatment in the countries surveyed. Many more, however, would benefit if treatment were made available to them. Combination antiretroviral treatment, typically three drugs taken daily, suppresses levels of HIV (the 'viral load') in the blood to undetectable levels and halts progressive damage to the body's immune system. By taking the drugs as prescribed, people living with HIV can stay healthy, well and productive. However, if there are interruptions in taking the drugs, for example because of cutbacks in funding for AIDS treatment programmes, HIV replication is no longer suppressed and life-threatening conditions will develop, drug resistance will increase and there will be an increased potential for HIV transmission.
The report describes how respondents in 11% of the countries surveyed (home to 427,000 people on treatment) reported that the global crisis had already affected treatment programmes in their countries. Respondents in 31% of countries, with 1.8 million people on treatment, reported that they expect impacts on treatment this year, while 30% of countries were unsure if treatment would be affected. Programmes were found to be especially vulnerable in sub-Saharan Africa, eastern and central Europe and the Caribbean.
Programmes are vulnerable for a variety of reasons, including declining household incomes (in Africa, for example, household out-of-pocket spending accounts for up to 60% of total health expenditures) and uncertain external aid assistance, but the report notes that the effects would be the same whatever the reason for programme curtailment: increased mortality and morbidity, greater transmission risks, higher financial costs in the long run and an increased burden on health systems as more ill people crowd public hospitals.
Prevention
For every two people accessing HIV treatment, another five people are becoming infected with HIV. Preventing new infections is therefore key to responding to the epidemic. However, the survey discovered that in 34 countries, where 75% of people with HIV live, prevention programmes for populations at higher risk are forecast to be affected. Programmes for these populations seem to be at risk because they are politically easier to cut; however, the consequences would be severe: less prevention that results in more new infections will mean greater future treatment needs, with large cost implications.
Responding to the crisis
While the results of the survey are worrying, the report does give recommendations on interventions that could help to address the crisis. Using existing funding better by moving resources from low-impact to high-impact programmes and addressing urgent funding gaps are highlighted as measures that should be taken. Monitoring systems, including for treatment interruptions, and the importance of planning for an uncertain environment are other issues that need to be given attention.
Resources:
Related information:
HIV Treatment - http://www.unaids.org/en/PolicyAndPractice/HIVTreatment/default.asp
Cosponsors:
World Bank
Press centre:
Press release: Global economic crisis threatens HIV prevention and treatment gains in poor countries (06 July 2009) - http://www.unaids.org/en/KnowledgeCentre/Resources/PressCentre/PressReleases/2009/20090706_PR_UNAIDS_WB_Report.asp
Download printable version (pdf, 82.7 Kb.) - http://data.unaids.org/pub/PressRelease/2009/20090706_pr_unaids_wb_report_en.pdf
Feature stories:
Top UN officials urge continued AIDS funding amid economic crisis (16 June 2009) - http://www.aegis.org/news/unaids/2009/UN090626.html
AIDS and global health (15 June 2009) - http://www.aegis.org/news/unaids/2009/UN090611.html
Funding for AIDS drugs in jeopardy as global financial crisis hits health sector (28 April 2009) - http://www.aegis.org/news/unaids/2009/UN090431.html
Publications:
The Global Economic Crisis and HIV Prevention and Treatment Programmes: Vulnerabilities and Impact (pdf. 1,09 Mb.) - http://data.unaids.org/pub/Report/2009/jc1704_econcrisis_hivresponse_en.pdf
Averting a Human Crisis During the Global Downturn: Policy Option from the World Bank's Human Development Network (pdf, 1.09 Mb.) - http://siteresources.worldbank.org/NEWS/Resources/AvertingTheHumanCrisis.pdf
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