Welt-Aids-Tag: „Das Schlimmste ist noch nicht vorbei”
Freitag, 30. November 2018 — Fast eine Million Menschen mit HIV sind im vergangenen Jahr an Aids gestorben – trotz neuer Forschung, Medikamente und Diagnoseverfahren. Zum 30. Welt-Aids-Tag sieht Médecins Sans Frontières/Ärzte ohne Grenzen (MSF) deshalb keinen Grund zum Feiern: „Die Welt hat sich an Nachrichten gewöhnt, in denen die Bekämpfung von HIV als Erfolg dargestellt wird. Und sicherlich ist an einigen Orten, insbesondere im globalen Norden, die Situation heute nicht mit der vor 30 Jahren vergleichbar. Der allgemeine Eindruck mag sein, das Schlimmste sei vorbei, doch so ist es nicht”, sagt HIV-Expertin Florence Anam. MSF befürchtet sogar eine Ära der Rückkehr von Aids.
Zwar werden heute 75 Prozent der Menschen mit HIV getestet, kennen also ihren Status, doch das allein reicht nicht. Die Menschen müssen auch Behandlungen erhalten und diese müssen finanziert werden. Doch die internationale Finanzierung geht zurück. „Ohne politisches Engagement und kontinuierliche Finanzierung wird es weder eine Ausweitung der Tests und Behandlungen noch eine Verringerung der Todesfälle durch Aids geben”, so die Expertin.
Viel zu wenig Behandlung für Kinder mit HIV
Von allen Kindern mit HIV erhielten 2017 nur die Hälfte die benötigte medizinische Behandlung. Denn in vielen ärmeren Ländern ist eine Therapie mit antiretroviralen Medikamenten nicht möglich, weil kindgerechte Versionen dieser Medikamente dort nicht verfügbar sind. Rund 90 Prozent aller Kinder mit HIV leben aber in Ländern Subsahara-Afrikas. Gerade dort kommt es zudem häufig zu Resistenzen gegen gängige HIV-Medikamente. Noch immer sterben viele HIV-positive Kinder im Laufe ihrer ersten vier Lebensjahre. An Aids-bedingeten Krankheiten starben 2017 weltweit 110'000 Kinder.
Vertreter internationaler Gesundheitsorganisationen und von Pharmaunternehmen verpflichteten sich vor einem Jahr, Kinder und Jugendliche mit HIV künftig besser mit Medikamenten zu versorgen. Seitdem gab es kaum Fortschritte. Am 6. und 7. Dezember treffen sie sich erneut. Inbesondere die Pharmaindustrie muss mehr und schneller in die Forschung und Entwicklung von kindgerechten Präparaten zur Behandlung von HIV investieren. HIV bei Kindern gilt darum nach wie vor als vernachlässigt.
Mehr Informationen zu den beiden Themen (auf Englisch) finden Sie untenstehend.
Interviews auf Deutsch zum Thema HIV bei Kinder sind möglich mit Sebastian Dietrich, medizinischer Leiter der MSF-Projektabteilung.
Dying of AIDS in the shadow of success
Author: Florence Anam, HIV advocacy coordinator, Medecins Sans Frontieres/Doctors Without Borders (MSF)
Today marks the 30th anniversary of World AIDS Day, an international day observed since the 1980’s when HIV diagnosis was a certain death sentence and life-saving antiretrovirals were a distant dream. I’ll be joining health staff in MSF’s HIV and TB projects across sub-Saharan Africa, in parts of Asia and Eastern Europe in reflecting on an uncertain future.
The world has become used to news stories presenting the HIV response as a success. Certainly in some places, particularly the global north, there is no way we can compare today with the situation 30 years ago. But if the last twenty years will be known as the ‘HIV treatment revolution’ with its massive strides in access to drugs and prevention tools thanks to vigorous international funding, from our vantage we fear entering an era of ‘the return of AIDS’. The general impression may be that the worst is over, yet it is not.
This year, UNAIDS reports that 75% of the 36.9 million people living with HIV know their HIV status, compared to just two thirds (67%) in 2015, and the fact that 59% of people have access to treatment. Yet a terrible flipside to this confident narrative of success is emerging. Global progress remains grossly uneven. There are also distressing indications that international donors are now disengaging from the fight against HIV.
Nearly a million people living with HIV died from AIDS in 2017, despite the available science, tools and diagnostics. Global death tolls from AIDS have barely dropped over the last years. The global goal of 150,000 fewer deaths a year hovers on the horizon like a mirage. The number of AIDS deaths in countries where MSF works remains staggering: Democratic Republic of Congo 17,000 deaths, Guinea 5,100 deaths, Kenya 28,000 deaths, Malawi 39,000 deaths, Mozambique 70,000 deaths and South Africa 126,000 deaths. Today 30% to 40% of people worldwide who test positive for HIV and start treatment do so with an alarmingly low CD4 count (below 200), an indicator of serious immune failure, and are at grave risk.
What is different today ago is that the majority of people presenting at the worst stages of AIDS already know their HIV positive status, with the majority already on antiretrovirals. In MSF supported hospitals providing care for AIDS patients the majority of patients had already been on treatment: Kinshasa (DRC) 71%, Conakry (Guinea) 62%, Homa Bay (Kenya) 60% and Nsanje (Malawi) 67% of patients. The inevitable challenges of daily treatment coupled with health systems that struggle to support them properly lead to people experiencing ‘treatment failure’, when they stop treatment or their treatment stops working for them. At worst, a significant proportion has developed resistance to existing treatment.
Yet without the political acknowledgement of continued high numbers of AIDS deaths, we will not see necessary action translated on the ground for people living with HIV. Measures to deal effectively with ‘contemporary’ AIDS remain glaringly absent from today’s HIV response. Health centres and hospitals must be equipped to quickly deliver lifesaving testing and treatment for people in advanced stages of HIV, and once recovered, guide them back to stable lifelong treatment, with a lifeline of second and third line treatment when needed.
At the same time, observations by MSF colleagues and HIV activists in Sub-Saharan Africa also indicate early signs of the deadly impact of a sharp drop in international funding that will affect millions of lives in the coming years. In countries heavily reliant on donor funding, for antiretrovirals specifically, a shortfall of international HIV funding and a treatment scale-down appear imminent at the most crucial moment. Where the last 20 years saw a generation of lives saved thanks to international solidarity, today a new generation are at risk of being lost as donors disengage.
Without additional resources, countries like Central African Republic and Guinea will be forced to reduce initiation rates instead of accelerating urgently needed scale-up as they face funding shortfalls for treatment in their 2018-2020 allocations from the Global Fund to Fight AIDS, Tuberculosis and Malaria.
Much has been said recently about the importance of HIV testing but it cannot be seen in isolation of the current funding context. Without secured funding to power HIV treatment and support, knowledge of one’s HIV-status is a real dilemma. People who test positive for HIV should have access to treatment, within health or community systems supported to deliver care. Without political commitment and ongoing funding, there will be no up-scaling of testing and treatment – nor a reduction in AIDS-related deaths.
World AIDS Day is about international solidarity with people who continue to fight for survival, struggling against barriers of neglect and discrimination. These are the people and patients who need our attention. World AIDS Day 2018 is about them, those who continue to die in the shadow of success.
Médecins Sans Frontières (MSF) has been involved in HIV care since 2000. In 2017, MSF provided antiretroviral treatment to 215,900 people in 27 in Africa, Asia and Eastern Europe, with a focus with a focus on implementing treatment strategies to reach more people earlier in their disease progression, and placing people living with HIV at the centre of their care. MSF is increasingly developing approaches to treat AIDS and address treatment failure, improve paediatric and adolescent HIV care, and improve the delivery of treatment in neglected contexts such as West and Central Africa and countries affected by conflict.
Paediatric HIV remains a neglected disease, and the small market for paediatric HIV medicines means they have never been a priority for either multi-national pharmaceutical corporations or generic manufacturers. Delays have plagued both the development and introduction of newer paediatric drug formulations, and scale-up of existing formulations.
Treatment coverage among children living with HIV is unacceptably low, with only 52% of HIV-positive children receiving treatment in 2017. Half of these children continue to receive suboptimal regimens, putting them at risk of increased side effects, resistance and treatment failure. In sub-Saharan Africa, home to 90% of all children living with HIV, there are high rates of resistance to existing HIV drugs, including nevirapine and efavirenz. The death rate among HIV-positive children remains high, especially during their first four years of life. In 2017, AIDS-related illnesses killed 110,000 children worldwide.
Ahead of a Vatican-organised meeting on the global response to paediatric HIV on 6-7 December, Access Campaign is issuing a press release addressing concerns about the lack of optimal treatment regimens for children living with HIV and the failure of major pharmaceutical corporations to deliver on their commitments.
Pharmaceutical corporations failing children with HIV
MSF criticises pharma for dragging feet on developing HIV drugs for children
29 November 2018—Ahead of a Vatican City meeting on scaling up HIV diagnosis and treatment for children, the international medical humanitarian organisation Médecins Sans Frontières (MSF) criticised pharmaceutical corporations for their delays and failure to develop appropriate formulations of HIV medicines for children. Developing countries are struggling to provide HIV-positive children with World Health Organization (WHO)-recommended treatments, because paediatric versions of these antiretroviral drugs are not available where they are needed
"Pharmaceutical corporations simply don’t consider children with HIV a priority, forcing us to use older, suboptimal treatments for the youngest people in our care that make it harder for them to stick to their treatment. Worse, increasing resistance to existing HIV medicines in sub-Saharan African countries means that the older treatments may not work in infants and children who are in urgent need of better treatment options,” said Dr David Maman, Medical Coordinator for MSF in Malawi. “How long will children with HIV have to continue to suffer or die because of pure indifference?"
Paediatric HIV remains a neglected disease, and the small market for paediatric HIV medicines means they have never been a priority for either multi-national pharmaceutical corporations or generic manufacturers. Delays have plagued both the development and introduction of newer paediatric drug formulations, and scale-up of existing formulations.
For example, the HIV drug dolutegravir – which is recommended by WHO as the preferred first-line treatment for infants and children, and was first approved for use in adults in 2013 – is still not available for children because pharmaceutical corporation ViiV Healthcare has yet to finalise necessary studies and register a dispersible tablet formulation for younger children. A paediatric granule formulation of another key drug, raltegravir, already exists, but pharmaceutical corporation Merck has been slow to register it in developing countries.
The alternative to dolutegravir recommended by WHO is the combination of lopinavir/ritonavir, but its paediatric formulation has also been plagued with problems. Generics manufacturers Mylan and Cipla have been very slow in scaling up the supply of the paediatric formulations (pellets and granules), and have also set their prices three times higher than the harsh-tasting lopinavir/ritonavir syrup that their products are supposed to replace.
At a meeting in Vatican City one year ago, representatives from global health organisations and executives from pharmaceutical corporations committed to increase access to treatment for children and adolescents living with HIV, but very little progress has been made. The meeting is being re-convened this year on 6-7 December.
“Children need access to the best and most robust medicines possible given that they need to stay on HIV treatment for life,” said Jessica Burry, HIV Pharmacist at MSF’s Access Campaign. “Pharmaceutical corporations need to stop dragging their feet and start taking concerted action so that more young lives can be saved – time’s up for empty promises.”
WHO recommends all children diagnosed with HIV immediately start antiretroviral therapy. But without optimal paediatric HIV drug formulations, countries will continue to struggle to implement this recommendation.
Treatment coverage among children living with HIV is unacceptably low, with only 52% of HIV-positive children receiving treatment in 2017. Half of these children continue to receive suboptimal regimens, putting them at risk of increased side effects, resistance and treatment failure. In sub-Saharan Africa, home to 90% of all children living with HIV, there are high rates of resistance to existing HIV drugs, including nevirapine and efavirenz. The death rate among HIV-positive children remains high, especially during their first four years of life. In 2017, AIDS-related illnesses killed 110,000 children worldwide.