JOHANNESBURG, 29 April 2009 (PlusNews) – After months of speculation about how the global economic downturn might affect HIV/AIDS programmes, a new World Bank report details the projected aftermath of the crisis and how it could place the treatment of more than 1.7 million at risk by year’s end.
Drug shortages, treatment interruptions and higher burdens of AIDS-related diseases are just some of the grim predictions for developing countries, laid out in a recently released report, Averting a Human Crisis During the Global Downturn: Policy Options from the World Bank’s Human Development Network.
A survey of countries representing about 60 percent of people on medication globally found that by the end of 2009, treatment programmes in more than a third would be directly affected by budget shortfalls due to the downturn. Prevention programmes are expected to fare even worse by funding being diverted to treatment programmes, where governments can more easily measure gains.
‘Social services are likely to suffer as governments cut back on spending, currencies devalue, and external aid donors come under pressure to maintain existing levels of foreign assistance,’ World Bank Group vice-president for human development Joy Phumaphi said in the report. ‘The downturn has taken a wrecking ball to the growth and development gains of the world’s poorest countries.’
The downturn is likely to hit southern and eastern Africa – epicentre of the HIV epidemic – hardest. Programmes in these regions are large and heavily reliant on donor funding, with little by way of home-grown resources that might cushion the blow of declining donor funding.
In 2008 the Global Fund to Fight AIDS, Tuberculosis and Malaria was forced to cut funding by 10 percent; this year, Global Fund recipient Tanzania announced that it planned to cut its national HIV/AIDS budget by 25 percent, and similar moves by Kenya and Sudan have already caused shortages of medical supplies in some areas, according to the World Bank.
The report forecasts that in countries like these, money will largely decide the age-old funding debate of ‘prevention versus treatment’, with renewed emphasis on funding but not necessarily scaling up treatment interventions, which produce short-term benefits that are easier to measure, rather than investing in prevention programmes.
Sex workers, injecting drug users and men who have sex with men – groups already lower on the prevention agenda than more visible groups such as pregnant women – are projected to suffer increased neglect in national efforts.
Countries will have to make hard choices to weather the downturn. The report recommended that nations highly reliant on foreign aid should identify any impending cash and drug shortages through early warning systems, and work to avoid treatment interruptions as far as possible.
Up to 50 percent of people who miss their daily dose of antiretroviral medication for two weeks or more may subsequently need a different, often more costly, treatment regime. Phumaphi said, ‘We cannot afford a ‘lost’ generation of people as a result of this crisis.’