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On World AIDS Day, infection rates are declining, but dwindling funds threaten progress

World AIDS Day on Wednesday is a chance to assess the impact of six years of heavy US and international donor funding.

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Funding for AIDS research and treatment seems to have stalled, a sign of donor fatigue during the ongoing global economic slowdown. ARV treatments are costly and become even more expensive, far beyond the means of developing countries, where the AIDS epidemic is centered. Aid groups such as Doctors Without Borders warn of a growing funding gap, and a withdrawal of donor support precisely when those funds are needed the most.

"In South Africa and the whole of Africa, if we do see a decrease in funding, it will mean we go back on all of the progress made so far after six years of heavy support," says Gilles van Cutsem, medical coordinator for Doctors Without Borders in South Africa and Lesotho. "We currently have about 1 million people on ARV therapy and there are plans to expand that to 2 million by 2016. You will go back to the days when people were dying because they didn't have access to ARVs. People will have to wait much longer to get access to ARVs, and when they do come to get treatment, they will be much sicker patients."

"Even South Africa will not be spared," Dr. van Cutsem says, "but in poorer countries like Mozambique, Lesotho, Swaziland, Zimbabwe, and Malawi, this will affect people much more quickly and more severely."

Van Cutsem said in a report released in May by Doctors without Borders that poorer countries are estimated to need about $20 billion in private donations over the next three years, but only $11.7 billion has been raised so far.

Thus, even as overall donor funding is increasing for AIDS relief, it isn’t keeping pace with the AIDS epidemic itself. According to the US Institute of Medicine panel of experts, external donor funding won’t ever be enough to provide universal treatment for AIDS.

“Because treatment will only reach a fraction of those who need it ... preventing new infections should be the central tenet of any long term response to HIV/AIDS in Africa," Dr. Thomas Quinn, co-chair of the Institute of Medicine panel that wrote the report, said at a news conference in Washington. He is also a professor at Johns Hopkins University in Baltimore and the National Institutes of Health.

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