Global economic crisis and HIV
06 July 2009
A joint Word Bank/UNAIDS report looks at the potential impact of the global financial crisis on HIV prevention and treatment programmes worldwide. Using data collected in March 2009 from 71 countries, the analysis looks at how the crisis could affect the nearly 4 million people living with HIV on treatment, and the 7 million who need treatment but don’t have access to it, and proposes some appropriate responses. The potential effects on prevention activities were also investigated. The report suggests that the well-being of millions of people could be put at risk.
The financial crisis started in the most-developed economies, but its impact has been felt in virtually all nations, leading to fears that donor assistance will remain flat or be cut, the budgetary revenues of developing countries will fall and worker remittances will decline. Many households may experience increased mortality and morbidity if the commitments made by the international community to sustain and increase access to antiretroviral treatment are not honoured and/or government expenditures on AIDS are reduced.
The report notes that an important lesson learned during previous crises is that cuts in core social development spending have long-term negative effects. Responding to fiscal pressures by reducing spending on HIV will reverse recent gains and require high-cost offsetting measures over the longer term.
Treatment at risk
At present, nearly 4 million people are on antiretroviral treatment in the countries surveyed. Many more, however, would benefit if treatment were made available to them. Combination antiretroviral treatment, typically three drugs taken daily, suppresses levels of HIV (the ‘viral load’) in the blood to undetectable levels and halts progressive damage to the body’s immune system. By taking the drugs as prescribed, people living with HIV can stay healthy, well and productive. However, if there are interruptions in taking the drugs, for example because of cutbacks in funding for AIDS treatment programmes, HIV replication is no longer suppressed and life-threatening conditions will develop, drug resistance will increase and there will be an increased potential for HIV transmission.
The report describes how respondents in 11% of the countries surveyed (home to 427,000 people on treatment) reported that the global crisis had already affected treatment programmes in their countries. Respondents in 31% of countries, with 1.8 million people on treatment, reported that they expect impacts on treatment this year, while 30% of countries were unsure if treatment would be affected. Programmes were found to be especially vulnerable in sub-Saharan Africa, eastern and central Europe and the Caribbean.
Programmes are vulnerable for a variety of reasons, including declining household incomes (in Africa, for example, household out-of-pocket spending accounts for up to 60% of total health expenditures) and uncertain external aid assistance, but the report notes that the effects would be the same whatever the reason for programme curtailment: increased mortality and morbidity, greater transmission risks, higher financial costs in the long run and an increased burden on health systems as more ill people crowd public hospitals.
For every two people accessing HIV treatment, another five people are becoming infected with HIV. Preventing new infections is therefore key to responding to the epidemic. However, the survey discovered that in 34 countries, where 75% of people with HIV live, prevention programmes for populations at higher risk are forecast to be affected. Programmes for these populations seem to be at risk because they are politically easier to cut; however, the consequences would be severe: less prevention that results in more new infections will mean greater future treatment needs, with large cost implications.
Responding to the crisis
While the results of the survey are worrying, the report does give recommendations on interventions that could help to address the crisis. Using existing funding better by moving resources from low-impact to high-impact programmes and addressing urgent funding gaps are highlighted as measures that should be taken. Monitoring systems, including for treatment interruptions, and the importance of planning for an uncertain environment are other issues that need to be given attention.
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The Global Economic Crisis and HIV Prevention and Treatment Programmes: Vulnerabilities and Impact (pdf. 1,09 Mb.)
Averting a Human Crisis During the Global Downturn: Policy Option from the World Bank's Human Development Network (pdf, 1.09 Mb.)