For HIV, only half the job is done

Women participate in an awareness session on HIV transmission at the Médecins Sans Frontières (MSF) mobile clinic in the neighbourhood of Sangoyah Market, Conakry, Guinea. Photo: Guinea 2016 © Sam Phelps

Earlier this month, UNAIDS announced that there are now more than 18 million people living with HIV worldwide who are receiving treatment. In comparing to where the world was even just a decade ago — when just 2 million people worldwide were on HIV treatment — this is remarkable progress, thanks in no small measure to the funding and commitment provided to rapidly scale up treatment. HIV is no longer a death sentence; it’s a manageable condition where people living with the disease are able to lead healthy, productive lives.

But let’s not fool ourselves. Only half the job is done.

While 18.2 million people living with HIV are receiving antiretroviral treatment (ART), a further 18 million living with the disease are not. With 1.1 million HIV-related deaths, and 2.1 million new infections in 2015, the end of AIDS is not in sight.

The World Health Organization recommends antiretroviral treatment for all people living with HIV, as early in their disease progression as possible. However in some sub-Saharan African countries, even where over 60% of people have access to treatment, hospitals supported by Médecins Sans Frontières (MSF) admit many people in advanced stages of the disease and with life-threatening opportunistic infections, such as tuberculosis. These people have either not been able to access ART on time, or to overcome the barriers to continue vital treatment for life.

As a doctor, I saw in Malakal, South Sudan, what we used to see in 2000 — people arriving too sick to be saved. But I remember one woman, who told me her story. She was diagnosed with HIV in 2013, but until MSF arrived, there was no way she could begin treatment. She was in the most advanced stage of the disease and had tuberculosis when she arrived at MSF’s facility. She started treatment and said the change was like magic; she could walk and work again. She was lucky — there are not many positive stories like this; unfortunately, many people died in our hospital before getting treatment. This cannot happen in 2016.

In Conakry, Guinea, where fewer than one in three people living with HIV have access to treatment, MSF is opening additional hospital capacity to care for people in critical condition. In Batangafo, Central African Republic, around a third of people with HIV who are hospitalised ultimately die, because they arrived too late to get tested for HIV and start immediate treatment.

Médecins Sans Frontières (MSF) mobile clinic in the neighbourhood of Tombolia, Conakry, Guinea. Photos: Guinea 2016 © Sam Phelps

People living with HIV face the double threat of HIV and conflict in South Sudan, Central African Republic and Yemen, where access to even a minimum package of HIV services is lacking, and ensuring continuation of antiretroviral treatment is a challenge for people, a problem that is often neglected by international actors.

Despite some increases in donor pledges to the Global Fund to Fight AIDS, TB and Malaria, the overall funding levels are below targets. According to UNAIDS, there is an annual gap of US$7 billion needed to curb the epidemic. UNAIDS reports an increase of 46% from national budgets over the past five years, but funding from international sources is going down, not up. Donor countries can’t let themselves off the hook by relying on domestic resources to pick up the slack.

All governments need to step up. Stagnated funding will result in stalled treatment scale-up. Unless international contributions pick up the pace, and available funds are used to fill existing gaps now, progress will stall at the very point in time when it needs to accelerate.

The reality is, without an increase in international funding, the 18 million people living with HIV without treatment will continue to go without. International donors and national governments alike must step up their efforts to increase financial support and improve their response to the disease as a matter of urgency.

For now, only half the job is done.

Dr Cecilia Ferreyra is a HIV/TB Medical Advisor and the International AIDS Working Group Leader for Médecins Sans Frontières.