Technical brief |

Threats to HIV treatment scale-up

The toolkit for fighting HIV/AIDS has improved drastically since ARVs were first introduced in public sector facilities in developing countries (1999/2000). Immediate antiretroviral therapy for people living with HIV, better drug regimens, and better treatment monitoring tests can better reduce needless infections, sickness, and death. World leaders have made ambitious political commitments to reach more people with life-saving treatment, 30 million by 2020. Right now we are more than half way there (with more than 19 million people on ART). However, to maintain the progress to date as well as reach the people who will die without acesss to treatment, action is required now.

In 2016, 1 million people unnecessarily died of HIV. New approaches to more effectively diagnose and treat people with HIV must be adopted and implemented widely, including; “test and start” approach to treatment, point of care diagnostic tests for infants, optimal  drug regimens, viral load monitoring, and better detection and treatment of opportunistic infections.

In this issue brief, we also take a specific a look at the West and Central Africa region which has been overlooked in the international HIV efforts despite being home to 18% of the global HIV burden.

To stem the HIV epidemic, UNAIDS estimates that overall US$ 26 billion annually will be needed by 2020, declining to US$ 24 billion by 2030.1 UN agencies and research institutes are thus calling for an additional US$7 billion per year. Yet, while domestic investments in the HIV response have seen a steady increase globally, donor funding is decreasing, from US$ 8.6 billion in 2014 to US$7.5 billion in 2015.2 This issue brief explores the troubling trends in the donor and global health actor funding landscape, including the Global Fundto Fight AIDS, TB and Malaria (GFATM) and the President’s Emergency Plan for AIDS Relief (PEPFAR), and the knock-on effects for governments, with a focus on middle-income countries facing the triple bind of higher prices, trade-related intellectual property laws and less donor support.

MSF calls for science and evidence not to be ignored, a donor commitment tailored to the urgent need to reduce treatment gaps and the spread of HIV, and world leaders to stay committed to fight the HIV epidemic, in every region and every country.


1 UNAIDS. Fact sheet. [Online] Available from: and “Fast-track update on investments needed in the AIDS response.” 2016. [Online].

2 Kaiser Family Foundation. Financing the Response to HIV in Low- and Middle-Income Countries: International Assistance from Donor Governments in 2015. July 2016. [Online]. Available from:


Threats to HIV treatment scale-up