Alarm bells over poor funding for HIV treatment

The lives of thousands of HIV-positive people in the Democratic Republic of Congo (DRC) are at risk as the country faces declining donor funding and a severe shortage of HIV treatment, according to Médecins Sans Frontières (MSF).

MSF recently launched a year-long advocacy campaign to raise awareness of the DRC's HIV crisis.

"The problem is quite old in the DRC; the country has always been minimized by donors who have not seen it as a priority, mainly because HIV prevalence is relatively low at between 3 and 4 percent," Thierry Dethier, advocacy manager for MSF Belgium in the DRC, told IRIN/PlusNews. "But look at the indicators: more than one million people are living with HIV, 350,000 of whom qualify for ARVs [antiretrovirals] but only 44,000 - or 15 percent - are on ARVs."

Dwindling funds

Dethier said the main reason for the ARV crisis was the end of six years of World Bank funding in 2011. International health financing mechanism UNITAID, which provides funding for paediatric and second-line ARVs, is also ending its funding to the DRC in December 2012; the cancellation of Round 11 funding by the Global Fund to fight AIDS, Tuberculosis and Malaria is only likely to worsen the situation.

Seventy-five percent of HIV funding in the DRC is from the Global Fund, 25 percent is from UNITAID through the Clinton Health Access Initiative - which provides funding for paediatric ARVs and second-line ARVS - and from the US President's Emergency Plan for AIDS Relief (PEPFAR), which funds prevention of mother-to-child HIV transmission.

"The country is currently using funds from round seven and eight of the Global Fund; these funds are due to be consolidated but have also been cut - round seven by 30 percent... round eight may also be cut," Dethier said. "We expect that the consolidated funds will last through 2014, after which there is no funding for DRC."

The DRC did not qualify for funding under the Global Fund’s ninth and 10th round.

At risk

According to the director of an NGO in the capital, Kinshasa, who preferred anonymity, funding problems mean many of his patients' lives are at risk.

"In Kinshasa alone we have shut two out of the three health centres we used to run, a situation which leaves us [caring] for only 1,800 out of 3,000 people living with HIV," he told IRIN/PlusNews. "Today we are running the one remaining health centre for HIV-positive people by charging each of them US$5 per month.

"When the funding was available patients could come for checking whenever they were feeling unwell... we do give them treatment but today we receive them once a month unless their health condition has deteriorated," he added. "We are now appealing to the government to intervene in filling the gap that Global Fund is leaving in funding interventions for people living with HIV."

Since there is no treatment people feel it's pointless to test. As many as 15,000 people have tested HIV-positive and qualify for treatment but are not receiving it

Dethier noted that there were also problems with HIV testing. "Since there is no treatment people feel it's pointless to test," he said. "As many as 15,000 people have tested HIV-positive and qualify for treatment but are not receiving it," he said.

Outlook

The Global Fund says it is reviewing a request for continued funding, and no life-saving programmes will be cut as a result of funding shortages.

"In terms of future additional funding, Round 11 was cancelled and replaced by a transitional funding mechanism that will allow countries to apply for funding for essential services for continuation of prevention, treatment and/or care services currently financed by the Global Fund," said Marcela Rojo, Global Fund spokeswoman. "Countries that face significant programme disruption between January 1 2012 and March 31 2014 may apply for up to two years of funding.

"This means that no recipient will be forced to suspend any essential services as a consequence of the round 11 cancellation," she added.

According to Rojo, with Phase 2 funding, the country aims to scale up treatment to 67,000 people by end-2014.

MSF's Dethier noted that other donors would have to step up their funding.

"With funding from the Global Fund, only 15 percent of people have access to ARVs, so we need others to contribute and we need the existing partners - UNITAID and PEPFAR - to honour their commitments to the people they are already supporting and to expand their programmes," he said. "The government aims to have 160,000 people on ARVs by 2014, which means putting roughly 3,500 people on ARVs per month - with money, this can be done."

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