A blast from the past. MSF used to say that the main constraint to scaling up antiretroviral treatment in the country was money. Now they are saying it again. There is no mention of the many other constraints.

Even an emergency donor conference suggested by the author will not solve the problems in Myanmar created by the cancellation of the Global Fund Round 11.

[him] moderator

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Aids funding retreat leaves lives in the balance in Burma
Joe Belliveau
The Nation
February 22, 2012 1:00 am

While international attention focuses on Burma, a health crisis in the country looms large.

An estimated 85,000 people infected with HIV in Burma are not receiving life-saving anti-retroviral treatment (ART).

This is an improvement on previous years, with new momentum in the country to tackle the crisis. However, the recent retreat of the Global Fund to fight Aids, TB and Malaria threatens to undo improvements, leaving tens of thousands of people living with HIV and TB without treatment and a large-scale crisis unchecked.

In 2008 just over 15,000 people infected with HIV, (less than 20 per cent of people living with HIV in Burma), received ART - the miracle treatment for HIV providing hope to millions around the world. An estimated 25,000 people died.

At the end of 2010, with the re-starting of the Global Fund in Round 9, in Burma, as well as the combined efforts of the Burmese Ministry of Health and non-governmental organisations working in country, the numbers able to access treatment increased to around 30,000.

Despite the improvement, an estimated 18,000 HIV sufferers died at the end of 2011 because of a lack of access to ART.

As the largest provider of HIV treatment in Burma, Medecins Sans Frontieres (MSF) sees men, women and children coming to our clinics on a daily basis in search of the life-saving drugs they urgently need. Often they arrive in a state of extreme weakness, co-infected with diseases such as TB. Because of limited resources and supply in the country, many only reach us at an advanced stage of the disease. MSF has more than doubled its capacity to treat HIV patients, from 11,000 to 23,000 in the years 2008-2012. We are reaching our limits.

This is a defining moment for Burma. Commendable efforts to rapidly scale up treatment and significantly close the large treatment gap have begun. A momentum to increase access has developed.

By 2018, with funds committed from Global Fund Round 11, a scale-up to 80 per cent ART coverage of people in need, and a substantially diminished treatment gap, was envisioned. However, the cancellation of the round of planning for the scale-up of additional treatment for 46,500 ART patients (43,000 adults, 3,500 children) has screeched to a halt. Without this increase in funding, doctors will continue to be forced to make impossible choices about who they can and can't treat.

This is a preventable situation - a crisis that can be mitigated if the appropriate funding is made available.

Meanwhile, another all too often related crisis is raging: tuberculosis, and the emergence of multi-drug resistant tuberculosis (MDR-TB). Many people in Burma go undiagnosed and untreated for MDR-TB because of the difficulties involved in getting a correct diagnosis, and the expensive and complex treatment. It takes around two years to treat an MDR-TB patient, compared with the usual six months for non-resistant TB patients.

In 2011 it was estimated that 9,300 new MDR-TB cases occur each year in Burma. In 2010, only 192 MDR-TB cases received adequate diagnosis, treatment and care.

Global Fund Round 11 funding was intended to target new geographic coverage for MDR-TB, to bring treatment centres to every state and region, reaching 10,000 MDR-TB patients in five years.

With the cancellation of Global Fund Round 11, tens of thousands of people living with HIV and TB in Burma will be left without access to treatment.

There is only one adequate answer to the HIV and TB crisis in Burma: treatment. With treatment, people's symptoms disappear, they can return to work, the fear and stigma surrounding these diseases reduces, as does transmission.

The only answer to ensuring access to treatment is sustainable funding. Governments must not shy away from their responsibilities.

First on the to-do list must be for Global Fund to hold an emergency donor conference so that affected countries such as Burma can apply for new grants and continue in their efforts to scale up the provision of treatment.

If Global Fund money is not forthcoming, it is essential that alternative solutions are found to plug Burma's treatment gap. Without it, people will continue to needlessly suffer and die. In Burma, tens of thousands of lives hang in the balance.

It does not have to be this way. The elements to close the gap between need and treatment for HIV/Aids and MDR-TB now exist in Burma. There is renewed political will, and in anticipation of additional funding, the Burmese Ministry of Health has taken positive steps to enable scale-up of treatment.

There cannot be a reverse in the gains made. Burma cannot be left to tumble further into a gap crisis. The decisions taken by donors are - quite literally - the difference between life and death.

Joe Billiveau is operations manager of MSF's operational centre in Amsterdam.

http://www.nationmultimedia.com/opinion/Aids-funding-retreat-leaves-lives-in-the-balance-i-30176394.html