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Africa: End of AIDS in Sight, 2

AfricaFocus Bulletin
Jul 27, 2012 (120727)
(Reposted from sources cited below)

Editor's Note

"As leaders and scientists prepare to discuss the latest initiatives needed to scale up treatment to such a high level it could potentially end the epidemic, seven million people still require urgent access to antiretroviral (ARV) treatment. While the United Nations AIDS agency (UNAIDS) estimates that 1.4 million more people were put on antiretroviral therapy in 2011, this pace will have to double to reach the global goal of 15 million people receiving treatment by 2015." - Doctors without Borders

Amid the plethora of reports, commentaries, meetings, and demonstrations this week at the International AIDS Conference in Washington, the consensus was wider than ever that success against the AIDS pandemic is in sight, but only if existing knowledge is applied with sufficient resources and commitment.

Two AfricaFocus Bulletins today select among the most readable and informative reports and commentaries appearing during the week.

This AfricaFocus Bulletin, not sent out by e-mail but available on the web at, contains (1) a report from PlusNews focused on increases in domestic investment on AIDS in affected African countries, (2) a commentary from Doctors without Borders on the need for stepped-up commitment by donors, (3) a news release from Kaiser Family Foundation and UNAIDS on trends in donor financing, and (4) a commentary from Huffington Post on how U.S. Trade policy is undermining the prospects for affordable generic drugs for AIDS and other diseases.

Another AfricaFocus Bulletin, sent out by e-mail today and available on the web at, contains several other recent articles, including (1) a summary article from PlusNews on the prospects for an "and to AIDS," (2) an op-ed by Anthony Fauci on the same theme, (3) an analysis by AIDS activist Mark Harrington on the Obama administration response to the AIDS pandemic, with proposals for additional action.

For previous AfricaFocus Bulletins on health issues, and additional background links, visit

++++++++++++++++++++++end editor's note+++++++++++++++++

Africa: Domestic investment in HIV up but uneven

This report online:

Nairobi, 19 July 2012 (PLUSNEWS) - Many sub-Saharan African nations - traditionally the beneficiaries of international HIV funding - are gradually increasing their financial contributions to the fight against the virus, boosting the number of people on treatment to record highs according to a new UNAIDS report, Together We Will End AIDS [], released on 18 July.

Low- and middle-income countries invested US$8.6 billion in the response in 2011, an increase of 11 percent compared to 2010, whereas the international community contributed $8.2 billion, a figure that has remained flat since 2008. The United States contributed nearly half of all international assistance for HIV/AIDS.

"This is an era of global solidarity and mutual accountability," Michel Sidibé, executive director of UNAIDS, said in a statement. "Countries most affected by the epidemic are taking ownership and demonstrating leadership in responding to HIV."

Increased local funding

In several African countries, including Kenya, Namibia, Sierra Leone and Uganda, domestic spending on HIV/AIDS rose by more than 100 percent between 2006 and 2011. In Botswana, Comoros, Mauritania, Mauritius, the Seychelles and South Africa, domestic investment accounted for more than 70 percent of AIDS funding.

The increases in funding allowed a record 6.2 million Africans to access life-prolonging antiretroviral treatment in 2011, compared to 5.1 million in 2010. The most impressive numbers in 2011 were seen in South Africa, which initiated 300,000 people on treatment, Zimbabwe (150,000) and Kenya (100,000). The recently released 2012 UN Millennium Development Goals report notes that Botswana, Namibia and Rwanda have achieved universal access to ARVs.

Increased access to ARVs has also helped reduce new HIV infections, with research showing that the medication reduces the transmission risk of people living with HIV. According to UNAIDS, new HIV infections have declined globally by 20 percent since 2011.

Since 2009, new infections in children have fallen by an estimated 24 percent. An estimated 330,000 children were infected with HIV in 2011, about half the number of those newly infected in 2003, the year considered the peak of the epidemic.

But the increased spending has failed to close a large gap in global funding for HIV, estimated to reach $7 billion by 2015, which is significantly short of the $24 billion target set at the 2011 UN High Level Meeting on AIDS. UNAIDS says a "concerted effort by all countries is needed to scale up funding if this target is to be met".

Not enough

"It is not enough for international assistance to remain stable - it has to increase if we are to meet the 2015 goals," said Sidibé.

In 2011, the Global Fund to Fight AIDS, Tuberculosis and Malaria took the unprecedented decision of cancelling its 11th round of funding after donors failed to meet commitments, denting treatment programmes in many countries.

"Globally we're finally past the half-way mark with HIV treatment, but that still means almost one in two people don't have access to the medicines they need to stay alive. The pace of HIV treatment scale-up and the funding needed to pay for it have both remained virtually stagnant over the last year," Dr Eric Goemaere, senior HIV/TB advisor at the medical NGO, Médecins Sans Frontières in Southern Africa, said in a statement in response to the UNAIDS report. "If we're going to reach all the people who need treatment, we have to double the pace of scale-up and double the funds."

He pointed out that "In places where we work, we see how fragile the progress is that has been achieved over the last decade. Health ministries are working hard to implement the latest treatment recommendations and policies to get ahead of the wave of new infections, but they can't do it alone."

Domestic spending by African governments has been uneven. In Malawi, which has an ambitious plan to put half a million people on ARVs by 2014, the treatment programme is almost entirely donor-funded - the government foots just five percent of its HIV bill - and the country's Global Fund grant comes to an end in 2014.

"The government is committed to fighting HIV, but the economy is not good at the moment and we rely completely on donors. Our programmes are running very well, but without donor support we can't manage on our own," Stuart Chuka, national HIV/AIDS programme officer in Malawi's Ministry of Health, told IRIN/PlusNews.

Need for continued support

"The cost of the ARV programme is almost the same as the total annual national health budget. For our human resources for health, we already have a problem, but with the Global Fund money running out it is going to be quite difficult - the money had helped us hire and retain more workers," he said.

Chuka noted that the country had adopted the latest UN World Health Organization guidelines to switch from the ARV, stavudine, to tenofovir (TDF) in first-line drug regimens, but insufficient resources meant not everyone could be put on the new drug. HIV-positive pregnant women, patients coinfected with HIV and TB, and those with severe reactions to stavudine are being prioritized.

In the Democratic Republic of Congo (DRC), a major World Bank project closed in 2011 after six years, while UNITAID, an international health financing mechanism for paediatric and second-line ARVs, will end its funding to the DRC in December 2012. The US President's Emergency Plan for AIDS Relief (PEPFAR) provides ARVs for prevention of mother-tochild transmission, but only for 18 months, after which patients are expected to be absorbed into the Global Fund's programmes.

The Global Fund - the major donor to DRC's HIV fight - expects to put some 32,000 new patients on ARVs by the end of 2014, but at least 430,000 people need the drugs. Just 12.3 percent of people who need ARVs have access to them, and MSF warns that unless more money is invested, ARV coverage will remain below 25 percent in 2015.

"One of the major problems is delays in seeking treatment - people in the DRC still pay between $15 and $25 for a CD4 test [a measure of immune strength]. At the MSF hospital in Kinshasa we are seeing at least one death per day - 50 percent of these are people who arrived 48 hours earlier - a clear sign of problems in HIV testing," said Thierry Dethier, advocacy officer for MSF in DRC. "Due to the shortage of international support, the government seems afraid to roll out its national testing programme, because it cannot assure HIV-positive patients of treatment."

Agencies working in DRC are hoping to see the government allocate at least $7 million to HIV/AIDS in this year's budget, as well as increased spending on health, which has not exceeded 6 percent of the national budget in the last decade.

"HIV prevention and treatment is needed for all, now and always," said UNAIDS' Sidibé. "I believe that together we will end AIDS. The question is not if, but when."


Donors must commit to fight the HIV emergency

Doctors without Border / Médicines Sans Frontières

19 July 2012

Johannesburg, 19 July 2012 - New United Nations data about gains made in the fight against HIV/AIDS is sparking optimism ahead of the 2012 International AIDS Conference in Washington. But countries most affected by the pandemic still struggle to place enough people on treatment and to implement the best science and strategies to fight the disease, Médecins Sans Frontières (MSF) warned today.

As leaders and scientists prepare to discuss the latest initiatives needed to scale up treatment to such a high level it could potentially end the epidemic, seven million people still require urgent access to antiretroviral (ARV) treatment. While the United Nations AIDS agency (UNAIDS) estimates that 1.4 million more people were put on antiretroviral therapy in 2011, this pace will have to double to reach the global goal of 15 million people receiving treatment by 2015. At the same time, international discourse is increasingly urging Africans to find their own domestic solutions to the HIV emergency.

African states cannot combat HIV alone

"It would be outrageous to assume that African states could combat this emergency alone, given their current limited resources," said Dr Eric Goemaere, MSF's HIV/AIDS senior regional advisor for southern Africa. "This is just a cynical excuse for donors to scale back on their earlier commitments of putting an end to this disease. It will have catastrophic consequences for patients."

In the Democratic Republic of the Congo (DRC), less than 15 per cent of patients who need ARV therapy receive it, 11 per cent of health facilities offer treatment, and less than 6 per cent of HIV-positive mothers have access to ARV drugs to prevent their children from becoming infected.

"We receive critically ill patients who have desperately searched for ARV treatment," said Thierry Dethier, MSF's advocacy manager in DRC. "For too many, their disease has progressed so far that they are literally dying on our doorstep."

International support stagnates

Several governments have taken important and courageous steps to address the HIV pandemic. Zimbabwe and Malawi have made major progress in broadening treatment programs in recent years. Malawi was the first country in Africa to implement prevention of mother-to-child transmission protocols, which foresee lifelong treatment for HIV-positive expectant or lactating mothers. Mozambique recently recommended a similar protocol, prescribing better firstline treatment and monitoring treatment progress by using viral load testing.

Yet, plans for scaling up treatment and improving quality of care risk being scrapped entirely as international support stagnates, with donors turning a blind eye to their earlier commitments. Important institutions in fighting the pandemic like the Global Fund are facing major funding shortfalls due to waning donor interest.

"In Malawi we're committed to implementing programmes based on recent scientific progress," said Stuart Chuka, national ARV treatment programme officer from the Malawi Ministry of Health. "Yet just as success is within reach, we're up against a great financial squeeze. I truly believe that we can end AIDS. But we can't do it alone."

Donor nation support for HIV stands firm but investments remain at 2008 levels

U.S. continues to account for more than half of all donor government investments

News Release

Wednesday, July 18, 2012

Kaiser Family Foundation and UNAIDS


Kaiser Family Foundation
Erissa Scalera
+1 202 347 5270

Sophie Barton-Knott
+41 79 514 6896

Washington, D.C., July 18, 2012- Donor nation funding in 2011 for HIV in low- and middle-income countries returned to prior levels after a drop in 2010, but has been roughly flat since the recession hit world economies in 2008, according to an annual funding analysis from the Kaiser Family Foundation and the Joint United Nations Programme on HIV/AIDS (UNAIDS).

The study found that donor governments disbursed US$ 7.6 billion in 2011 for the AIDS response in low- and middleincome countries. Overall donor government support for AIDS has been flat since 2008, which marked the end of rapid increases in donor disbursements of more than six-fold over the 2002 to 2008 period.

"International investments still account for two thirds of funding for HIV in Africa, the continent most affected by the epidemic," said Paul De Lay, Deputy Executive Director, Programme at UNAIDS. "Although more and more countries are increasing domestic investments for HIV, investments from donor governments remain an essential resource."

"The benefits of early detection and treatment have never been more clear, but countries have never been more challenged to provide needed resources. This is a critical time to keep the focus on the HIV epidemic," said Drew Altman, Kaiser Family Foundation President and CEO.

The two largest donor governments – the United States and United Kingdom – reported funding increases. The United States, the largest donor nation, reported a US$785 million increase in disbursements over 2010, but only returned to 2009 levels after reporting a delay in disbursements as the reason for last year's decline. Australia, Canada, Denmark, France, Germany, Norway and Sweden maintained or slightly increased their support, while Ireland, Italy, Japan and the Netherlands decreased funding.

In 2011, the United States accounted for more than half (59.2%) of total donor government disbursements, followed by the United Kingdom (12.8%), France (5.4%), the Netherlands (4.2%), Germany (4.0%) and Denmark (2.5%).

When considering what constitutes a donor's "fair share" – which this report assesses by looking at donor resources standardized by the size of government economies – Denmark provided the highest amount of resources for AIDS in 2011, followed by the United Kingdom, the Netherlands, Ireland and Sweden. The United States was sixth.

According to the latest estimates from UNAIDS, 34.2 million (31.8-35.9 million) people were living with HIV at the end of 2011. Nearly 35 million have died from AIDS-related causes since AIDS was first reported 31 years ago.

The new report provides that latest data available on donor funding based on data provided by governments, and were collected and analyzed by researchers as part of a collaborative effort between the Kaiser Family Foundation and UNAIDS.

The full analysis is available online at

International AIDS Conference Sparks Protest Of Obama Trade Policies

Huffington Post

Zach Carter 07/24/2012

[For additional background on this issue, see the Issue Brief from Doctors without Borders, "Trading Away Health," published this week and available at}

Washington -- Thousands of people marched on the White House and the Office of the U.S. Trade Representative on Tuesday to protest a new trade agreement that public health experts warn would cut off access to life-saving medications for AIDS patients.

The protests are tied to the International AIDS Conference, a week-long event in the nation's capital devoted to improving global treatment programs, sharpening public policies and ending the disease. Thirteen people were arrested after hanging AIDS ribbons on the White House fence and refusing to clear the street in front of the White House. Thousands of others decamped across the street to Lafayette Park, chanting, "Obama, come out, we've got some sh*t to talk about!"

Activists in Washington this week are demanding a handful of policy changes related to HIV/AIDS, including immediate treatment for the thousands of low-income Americans currently on waiting lists for HIV drugs, the full implementation of Obama's domestic health care reform bill, increased global AIDS relief funding and an end to free trade agreements that inflate the prices of drugs around the world by granting long-term monopolies to pharmaceutical companies.

Hundreds of public health organizations have backed the agenda, which is posted online at Many were present at the protests, including representatives of the American Medical Student Association.

Nevertheless, President Barack Obama's administration has opposed many of policy changes, cutting global AIDS funding under the popular PEPFAR program, while pursuing trade policies that economists say increase the prices of AIDS medications, cancer drugs and other life-saving medications both at home and abroad.

By contrast, Obama's Affordable Care Act contains a host of provisions to broaden and lower the cost of domestic health insurance. Those policies should make insurance more widely available and less expensive for HIV patients. Obama's trade policies, however, could ultimately increase the cost of that insurance.

Trade protesters were especially prominent at the afternoon's event. Several held banners objecting to the Trans-Pacific Partnership, a major trade deal that the Obama administration has been negotiating with 10 Pacific nations for the past three years. According to leaked drafts of the talks, American negotiators are pursuing a host of intellectual property terms that would lengthen drug company monopolies on medications, including drugs introduced in Vietnam, a developing nation that receives PEPFAR funding from the U.S. These policies, in turn, put upward pressure on drug prices all over the world. The negotiating texts for the trade pact are kept secret from the public, but more than 600 corporate advisers, including representatives of drug companies, can access them through positions on official advisory boards.

"Fire Ron Kirk!" protesters chanted Tuesday, referring to the head of the Office of the U.S. Trade Representative, the agency formally tasked with negotiating the deal.

UNAIDS, the United Nations' anti-AIDS group, also criticized the policies being pursued under TPP in a June report.

Doctors Without Borders released a new report to coincide with the conference, analyzing leaked provisions of the TPP, which concludes, "If the U.S.'s demands are accepted, the TPP agreement will impose new IP rules that could severely restrict access to affordable, life-saving medicines for millions of people."

USTR spokesperson Carol Guthrie told HuffPost her agency is taking into account feedback on its efforts, including feedback from Tuesday's protests. "USTR has gotten a great deal of feedback on our early TPP proposals and we are in fact reflecting carefully on it, and want to continue to work with all stakeholders on getting this policy right," Guthrie said, pointing to a recent Kirk-penned blog post that emphasized the need to balance the intellectual property incentives for drug companies with the treatment concerns.

She also pointed to a Sunday statement from the White House that said, "The Obama Administration remains steadfast in its commitment to people living with, or affected by, HIV throughout the world."

But such statements appeared to hold little comfort for the protesters on Tuesday, who carried signs declaring, "PFIZER + OBAMA'S TPP = DEATH FOR PEOPLE WITH AIDS," and "RON KIRK: TRANS-PACIFIC TRADE DEAL KILLS."

The protests are particularly pointed for the Obama administration for taking place in Washington, where the president is more popular than in any state in the nation. Yet the district features a higher AIDS/HIV rate than any other area of the country, making AIDS policy issues a matter of deep significance to the city's residents. At 3.2 percent, the HIV infection rate in D.C. is more than triple the rate the World Health Organization uses to identify epidemics, and is higher than the rate in many developing nations.

Doctors have long known that HIV drugs can prolong a patient's life for decades. But access to such medicines became an even higher priority issue over the past year, after research was published showing the medications were also 96 percent effective at preventing transmission of the disease to others.

AfricaFocus Bulletin is an independent electronic publication providing reposted commentary and analysis on African issues, with a particular focus on U.S. and international policies. AfricaFocus Bulletin is edited by William Minter.

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