Global aids ignore AIDS

June 13, 2011  
Archana Jyoti | New Delhi

GFCST, DFID & Gates Foundation have expressed inability to keep up or hike funds  

India’s HIV/AIDS control programme faces a serious crisis as many top international donors are withdrawing due to economic recession, other health priorities, and, above all, the fact that India has failed in sustaining the programme despite funding.

Key funding agencies like Global Fund For Care, Support and Treatment (GFCST), UK Department For International Development (DFID), and Gates Foundation have already expressed their inability to either continue or enhance funds for the country’s AIDS control programme.

The GFCST has slashed the budget for the period April 2010 to March 2016 from $530 million to $420 million, while the Gates Foundation announ-ced early this year its decision to wrap up its $338 million fund programme after 2012.

Financial aid from World Bank too will no longer be easy, admit officials of National AIDS Control Organisation (NACO), as interest rates have become competitive for emerging economies like India.

In fact, there is a clear linkage between global funding and NACO’s budget. For example, when there was a substantial reduction in global funds in 2009-10, NACO too followed suit reducing its budget by Rs 100 crore.

“NACO had submitted a proposal of $530 million to GFCST. However, of these, only $420 million have been approved for the period of six years (April 2010 to March 2016). The entire CST (care support and treatment) budget is funded by grants received from the global fund,” NACO said in an affidavit filed before the Supreme Court last year.

With a major share – 75 per cent of India’s total budget for AIDS control programme – coming from international donors, USAID in its recent report warned that the fund crisis will hamper various HIV/AIDS projects. “It is a must (for the Indian Government) to ensure adequate domestic funds and synchronise the AIDS control programme with the national five-year plan to curtail the spread of the killer disease,” it said.  

India is home to the world’s third highest caseload with 2.5 million infections after Nigeria and South Africa.

According to Dr Charles Gilkes, country co-ordinator, UNAIDS, the fund allocation for HIV/AIDS by major donors like World Bank, Global Fund and the UK Government was not increasing.

India is spending a meagre 1 per cent ($5.4 billion) of its GDP on healthcare facilities – much less than that in some African countries – out of which only about 5 per cent goes for treating AIDS patients, and balance to combat deadly diseases like tuberculosis Malaria, and on women and child health-related programmes.

Prasada Rao, Executive Director with the UNAIDS, said that India seriously needed to enhance its health spending and stop looking towards outside sources so that AIDS prevention programme are not affected. “Increasing cost of drugs would be a major headache for the fund-starved India once the patents and TRIPS rules are enforced,” he added.

But what has worried the authorities is that the investment is shrinking at a time when the AIDS responses are delivering results — cases have reduced by over 50 per cent over the last ten years. But as there is still a huge gap to address, the resource crunch could reverse the trend.

“There is no room for complacency. Many patients still have no access to treatment, posing threat to the prevention measures. If funding is not secured we might be back to the square one position,” said former Health Secretary Sujatha Rao.

India still has a daunting task ahead to combat the menace. Of 24 lakh HIV positive patients, only around 3.50 lakh are getting life saving anti-retroviral therapy (ART). New WHO guidelines recommending early treatment will add ten lakh HIV patients to the list. Early adherence to an effective anti-retroviral regimen reduces the risk of transmitting the virus to his or her uninfected sexual partner by 96 per cent.

While some patients have developed resistance to first-line ART, there is a little money for expensive second and third line treatments. Only around 1,500 are getting second-line treatment.  

“What does the Government want? That there is no money and patients should die?” Anjli Gopalan from Naaz Foundation asked as she stressed that the National Action Control Plan-IV to be kicked off from 2012 ensure all these basic needs of the sector.

And with reports of HIV cases showing sign of rising in parts of New Delhi, Mumbai, and the north and northeast among other areas, the cost of treatment could rise to $1.8 billion by 2020, about 7 per cent of the total health expenditure from the present five per cent, says the World Bank.

” We are worried about the concentrated epidemics in the country, among vulnerable groups in districts,” said Mariam Claeson, World Bank Program Coordinator (HIV/AIDS).

With limit resources, NACO officials say they are focussing more on giving first line ART than the second line ART, but activists are not impressed. “Of what use will the first line ART be if India cannot manage to start second line ART programme?” Stanzin Dawa of the International AIDS Alliance in India and Loon Gangte of the Delhi Network of Positive People asked.

While India’s economic growth has been forecast to hover around 8.5 per cent for next few years, authorities acknowledge there is a need to put financing mechanisms in place to meet fund shortage of combating HIV/AIDS. Till then it will be impossible for India to meet its promise to the recently held UN General Assembly to set specific targets on elimination of HIV/AIDS through reduction in sexual transmission, elimination of mother to child transmission and extending the availability of put more number of patients on Anti Retroviral Therapy by 2015.  

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