The global fight against HIV/AIDS, an epidemic that killed about 1.8 million people last year, is at a critical crossroads. On the one hand, new scientific evidence offers promise to finally stem - if not reverse - the epidemic and governments have given ambitious commitments.
Sadly, on the other, the funding needed to turn this year's scientific and political breakthroughs into increased access to treatment for millions of people is severely lacking, threatening to undermine not only future advancements but also existing programs and ultimately denying people live-saving treatments.
Now is a critical moment for key international donors such as Australia to ensure that this opportunity to save millions of lives is not lost.
During our 10 years of providing anti-retroviral treatments to HIV patients in resource-poor settings, Mdecins Sans Frontires/Doctors Without Borders have witnessed time and again how treatment dramatically reduces illness and deaths in the communities where we work. Now landmark scientific evidence released this year shows that early HIV treatment not only saves lives but also reduces the risk of new infections to a partner by 96 per cent. This shows that HIV transmission can be significantly reduced if more people are placed on HIV treatment earlier in their disease progression.
According to UNAIDS, expanding treatment and pairing it with other high impact interventions can avert more than seven million deaths and 12 million new infections by 2020.
In recognition of these findings, the UN agreed to a bold new declaration to fight AIDS, which Australia played a lead role in getting all UN member states to endorse in June this year.
This included the target of increasing the number of people on HIV treatment to 15 million by 2015, from 6.6 million today. Sadly, drastic funding shortfalls stand to jeopardise this opportunity to finally curtail this epidemic. The Global Fund to Fight AIDS, TB and malaria, the largest multilateral funder of HIV treatment, financing more than 70per cent of anti-retroviral drugs in resource-poor countries, is facing serious funding shortages. As a result the fund was forced to cancel an entire round of funding, an unprecedented event in its 10-year history. The impact will be devastating. If countries are left without the support they need to provide HIV treatment to new patients, people in need will be forced to wait for prolonged periods.
Treatment rationing may also be on the horizon, with doctors having to select patients to give treatment to rather than providing it to all those who seek it. In Southern Africa, where MSF have been running HIV/AIDS programs for the past 10 years, we know treatment rationing all too well, having started treatment when there was not enough funding to cover the then high price of drugs.
It seems unthinkable to me that today, when the science and political will are behind us, people living with HIV cannot obtain the affordable life-saving treatment they urgently need.
MSF teams on the ground have surveyed national HIV/AIDS programs in areas where we work in an effort to provide a clearer picture of national ambitions and the threats these nations face in fighting the epidemic.
MSF found that several countries have been forced to scale back ambitious strategies because of stagnant or declining budgets. And, more worryingly, in some countries such as the Democratic Republic of Congo, Mozambique and Zimbabwe, existing national treatment programs are under threat of being severely curtailed, effectively reversing progress.
There is an urgent need for international donors to step up to the plate to provide the funding needed. Australia has been an international leader in the fight against HIV/AIDS.
While some other donors have been reducing or even freezing funding for the Global Fund, Australia increased its contribution by 55 per cent for the three-year period 2011 to 2013.
In this moment as we stand on the brink of actually being able to stem, and maybe even reverse HIV/AIDS, the leadership of major donor countries like Australia is vital.
MSF urges Australia to boldly step into this leadership role by providing continued and increased funding for HIV/AIDS programs and proactively advocating that all countries do the same.
Next year will be critical for the global fight against HIV/AIDS, where we can either make significant inroads, or let the opportunity to save millions of lives be squandered.
I hope that next World AIDS Day Australia can reflect proudly on its leadership in successfully combating the most deadly epidemic of our generation.
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