A recent report based on a survey by UNAIDS and the World Bank revealed the negative effects of the global economic crisis on HIV/AIDS treatment and prevention programs worldwide. Of the 71 countries surveyed in March, 34 countries, which comprise 75 percent of people living with HIV, reported the economic conditions had already impacted prevention programs that focus on high-risk groups including sex workers, people who inject drugs, and men who have sex with men.

With global markets worsening, local and international program leaders anticipate shortages of government and external funding for many HIV programs on which millions of people depend. Because prevention programs for high-risk groups are socially and politically easy to cut, researchers and HIV respondents worry transmission rates of the disease may rise, straining health care systems in the future.

René Bonnel, leading author of the study and member of the World Bank’s Global HIV/AIDS Program, said struggling economies must focus on ways to maintain both treatment and prevention programs.

“In many countries, a lot of funding has supported treatment programs without providing equal amounts to prevention programs,” Bonnel said. “It’s quite unbalanced and unsustainable because it allows the number of infections to increase, raising overall costs in the long run.”

Bonnel and other contributors predict that developing countries — where HIV prevention and treatment is maturing — will be the most negatively impacted. Twenty-two countries in Africa, the Caribbean, Europe, central Asia, and the Pacific have already experienced funding and service cuts to programs.

Bonnel said he does not think HIV/AIDS patients in the U.S. and other industrialized countries will be significantly impacted by economic conditions.

“In the U.S. especially, there are many schemes that guarantee access to treatment,” he said. “It’s really a problem for countries without firm reimbursement.”

The report also suggests that individuals who depend on antiretroviral therapy, which consists of at least three anti-HIV drugs, will have problems affording treatments because of the devaluation of national currencies. Job losses and declining incomes will also make health care programs harder to afford in the future.

Eight countries already reported antiretroviral drug shortages, according to the survey. Bonnel said increasing numbers of HIV-positive patients in developing countries are coming forward requesting treatment, and programs are too disorganized to pay for and deliver massive amounts of antiretroviral drugs. Only one third of HIV-positive patients who request treatment receives it, he said.

Bonnel and others also expressed concern about treatment being interrupted by funding problems. Interrupting or discontinuing anti-HIV treatment can have serious, if not fatal, implications for people with HIV. Most people who stop treatment and do not restart die within 2 years, and patients can develop resistance to antiretroviral drugs if treatment is interrupted for up to 30 days.

To curtail future problems, collaborators with UNAIDS, the World Bank, and the World Health Organization outlined suggestions to maintain and broaden access to HIV prevention and treatment amid national and international crises. According to the report, a few steps are more critical than others, and HIV/AIDS programs should:

• Use existing funds better by reallocating resources from low to high impact prevention and treatment projects
• Address urgent funding gaps by expanding funding sources to more national and international funders
• Monitor the risks of program interruptions by carrying out regular surveys to determine if countries need more resources
• Plan for uncertain environments by creating contingency plans to maintain prevention activities despite funding problems.

Most importantly, leaders worry that if economic troubles persist, recent progress with the disease may unravel in the next few years. Based on a 2008 report on the global AIDS epidemic, HIV transmission was stabilizing at a global level. UNAIDS and the World Bank hope to maintain, rather than lose, this progress.

“Treatment goes much beyond one person,” Bonnel said. “Treatment keeps people working, lets children remain in school, and creates hope for a better life in the future.”

He said that maintaining treatment and prevention programs is a productive investment with secondary effects.

“Countries have to find a different financing mechanism. One cannot always expect to rely on external and international aid,” he said. “They must develop some sort of insurance scheme. This isn’t the type of problem that’s going to disappear in the next 5 years.”