The global community has itself the tough task of eliminating HIV by 2030 as per the newly adopted sustainable development goals. With funds to improve treatment quickly drying up, that task has become tougher. “We will not be able to end AIDS,” said Michel Sidibé, executive director of UNAIDS, speaking at the AIDS 2016 conference organised by the International Aids Society in Durban, South Africa. "If we don’t pay now, we will have to pay later."
According to Sidibé, 13 of the 14 funding nations have reduced their contribution towards HIV-related projects globally. “There is at least a 7% drop in funding between 2015 and 2016,” he said and estimated that funding had fallen from $9 billion to $8.2 billion in the past year.
According to an estimate by UNAIDS and the healthcare non-profit Kaiser Family Foundation, funds fell to as low at $7.5 billion in the previous year.
According to UNAIDS projections, about $26.2 billion will be needed for the international AIDS response in 2020, and $23.9 billion in 2030.
In fact, several HIV/AIDS projects in India are witnessing the impact of the fund crunch. Though the World Health Organization recommends antiretroviral medications for all person living with the HIV virus, India’s National Aids Control program provides free medication to those in dire need with CD4 counts less than 500 units. The lack of funds will restrict free treatment to this group of patients. “We have enough money to run the existing operations but if you want us to expand, it is going to be difficult with the current funding,” said Naresh Goel, deputy director of the program who is representing India at the conference. "Earlier the contribution of international funding for the HIV/AIDS program was over 40%, but today the ratio is 30:70 where the government is contributing more."
Pehchaan, a non-profit working with transgender women in 18 states in India, has stopped its AIDS project after funds from an international donor dried up. “We are looking at alternative funding,” said Amitava Sarkar, who works with Pehchaan and is at Durban to showcase the impact of the organisation's interventions in reducing HIV infections in Indian transgender communities.
India has the third-highest number of people living with HIV in the world, according to a UNAIDS report, even as the number of new infections are falling. Despite the progress, experts at the conference concluded that at least half of those living with HIV still do not have access to treatment. Also out of reach are new tools like pre-exposure prophylaxis, which is a pill that prevents HIV infections in those who are HIV negative but might be at risk of contracting the virus.
Sidibé urged the donors to continue their funding. “If we stop now, we will see a resurgence in the epidemic,” he said.
Contain or cure?
Meanwhile, medical researchers around the world continue to look for a cure to HIV, a way of eliminating the virus entirely. Even the International AIDS Society is focussing its attention on a plan to look for an HIV cure.
But at the AIDS 2016, several people living with the virus thronged the streets of Durban urging for better access to anti-retroviral medicines instead. Anti-retroviral medicines have helped turn HIV from a fatal to a chronic condition. As of December 2015, 17 million people living with HIV were accessing antiretroviral therapy.
Many experts do not see the point of investing in cure when the access to the available ARV treatment is a challenge. Though there is funds crunch for treatment and prevention activities related to HIV, a report by the International Aids Society indicates the rise in investments related to researches that promise a cure for the virus.
Between 2011 and 2015, the working group of the International Aids Society estimates a 129% increase in the investment in research related to studies that aim at finding cure for the viral infection. The situation is similar in India where the funding for research which aim at looking for curing HIV has increased from $0.03 million in 2012 to $2.1 million in 2015.
“With $7 billion more a year (in international monetary aid), we could be moving towards ensuring all people living with HIV have access to treatment, but instead they (international governments) are trying to convince us we should chose-which people, which geography, which age or gender or sexuality-because there is not enough money,” said Asia Russell, executive director of the Health Global Access Project.
Holy grail or a fool's errand?
Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, says he has no answer about when or if at all there will be a cure for HIV.
There are two approaches to the HIV problem. “First, eliminate the virus completely from a person’s body and second is to control the viral load of HIV in the body without it’s elimination,” said Fauci.
More than 50 research studies are underway across the world to look for a cure but a panel of leading researchers at AIDS 2016 are convinced that more needs to be done. “We are spending a miniscule amount of what we are spending on treatment and prevention,” said Fauci when asked about the rationale behind spending on cures when many are deprived of treatment.
The most promising of all studies are related gene modification, said Fauci. Researchers at the Fred Hutchinson Cancer Research Centre in Seattle are working towards cell and gene therapy approaches targeting HIV. Another group at University Medical centre in Utrecht is conducting allogenic stem cell transplantations in people infected with the HIV-1 virus.
Growing virus resistance
The fund crunch is also leading to an increase in resistance of the HIV virus. A World Health Organisation report on early warning indicators of HIV said that less is known about India’s success in minimizing emergence of HIV drug resistance when compared to other countries. As a part of the study, during the period 2013-2014, India monitored the quality of its HIV treatment program using WHO recommended early warning indicators of HIV drug resistance at 62 clinics nationally. While every person put on treatment received the appropriate medication as per the monitoring, adherence to treatment seems to be a problem.
The report found that only 67% of people living with HIV continued their antiretroviral medicines after 12 months. The WHO-suggested target for this parameter is more than 85%. The report also found that stock outs of routinely dispensed HIV medicines occurred during quarter of the reporting period.
“If you have interruptions in supply people don’t take their medicines regularly, which will lead to resistance, taking us away from our goal,” said Mandeep Dhaliwal, director of the United National Development Programme's HIV and health project.
