Global Economic Crisis Threatens HIV Prevention and Treatment Gains in Poor Countries

Geneva, July 6, 2009 – In 22 countries in Africa, the Caribbean, Europe and Central Asia, and Asia and Pacific, disruption of HIV prevention and treatment programs is expected over the course of this year as a result of the global economic crisis, according to a new report from UNAIDS and the World Bank, released today.

According to the new report, ‘The Global Economic Crisis and HIV Prevention and Treatment Programmes: Vulnerabilities and Impact’, reports from agency staff in 71 countries indicate that eight countries are already facing shortages of antiretroviral drugs or other disruptions to AIDS treatment. Together, these countries are home to more than 60% of people worldwide receiving AIDS treatment. 

HIV prevention programs are also in jeopardy. In 34 countries, representing 75% of people living with HIV, respondents say there is already an impact on HIV prevention programmes focusing on high-risk groups such as sex workers, people who inject drugs and men who have sex with men. 

°This is a wake-up call which shows that many of our gains in HIV prevention and treatment could unravel because of the impact of the economic crisis,” said Michel Sidibé, Executive Director of UNAIDS. “Any interruption or slowing down in funding would be a disaster for the 4 million people on treatment and the millions more currently being reached by HIV prevention programmes. We need to show solidarity with people living with and affected by HIV just as they are beginning to hope for a better future.”

Antiretroviral treatment vulnerable 

The joint report says that in some countries the affordability of antiretroviral treatment is affected by falling household income and wages and/or increased cost of antiretroviral drugs caused by exchange rate devaluation. 

Furthermore, the report suggests that poor nutrition could also force people to stop their life-saving treatment because not eating enough of the right foods can impair the effectiveness of their drugs. Community networks, which are the only social safety net for the poor are also being crippled by the financial crisis to the point of collapse and some respondents report that the availability of antiretroviral treatment is being threatened by budget cuts. 

Many respondents are concerned that the financial sustainability of antiretroviral treatment programmes that depend mainly on external aid is uncertain. There are no reports of substantial cuts in donor assistance for 2009, but respondents in nearly 40% of the surveyed countries report that the current funding commitments for treatment programmes will end in 2009 or 2010, and most fear that external assistance will not increase or even be maintained at current levels.

°This evidence shows us that people on AIDS treatment could be in danger of losing their place in the lifeboat and bleak prospects for millions more people who are waiting to start treatment,” says Joy Phumaphi, the World Bank’s Vice President for Human Development and a former Health Minister for Botswana. “We cannot afford a ‘lost generation’ of people as a result of this crisis. It is essential that developing countries and aid donors act now to protect and expand their spending on health, education and other basic social services, invest effectively and efficiently, and target these efforts to make sure they reach the poorest and most vulnerable groups.”

HIV prevention efforts especially under threat 

The report describes how respondents in 34 countries, where 75% of people with HIV live, expect prevention programmes for populations at higher risk to be affected. Respondents say that prevention efforts for populations at higher risk are especially vulnerable, because they are politically easier to cut. This is extremely worrisome – less prevention that results in more new infections will mean greater future treatment needs, with large cost implications. 

Urgent measures needed

UN Secretary-General Ban Ki-moon has highlighted the economic crisis as a cause for global concern and underlined the importance of turning the economic crisis into an opportunity for a sustainable future. The UNAIDS/World Bank report outlines a number of urgent steps which are needed to maintain and expand access to HIV treatment and prevention during the global economic crisis and beyond. 

Use existing funding better – Despecially in countries facing cuts in their national AIDS response budgets, governments and aid agencies should provide technical support to reallocate resources from low- to high-impact prevention and treatment programmes. All countries should seek ways to make programmes more efficient and more cost-effective.

Address urgent funding gaps – Dcountries with a high reliance on external funding for HIV should strengthen collaboration between national authorities and major international funders to identify and address impending cash-flow interruptions and arrange bridge financing as necessary to avoid cash-flow interruptions. 

Monitor risks of programme interruption – a simple warning system could be established to anticipate and minimize treatment interruptions. A key component of such a system would be to carry out regular surveys to identify “vulnerable” countries and provide tailor-made financial and policy assistance. 

Plan for an uncertain environment¨Dthe uncertainty that many respondents note calls for contingency planning: contingency plans could consider changes that could be made to ensure continued access to treatment and realistic expansion plans, and to maintain the most effective, highest priority prevention activities under alternative potential funding scenarios. The report recommends that resource mobilization strategies include sources of finance that can be sustained over the long term.

To see more of the new report  ‘The Global Economic Crisis and HIV Prevention and Treatment Programmes: Vulnerabilities and Impact’, visit

UNAIDS Geneva | Sophie Barton-Knott | 
World Bank Washington | Phil Hay |


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