There is now evidence from the field that the impact of the recent financial crisis on households with people living with HIV (PLHIV) is severe. Highlighting this, the eminent speakers at the symposium discussed various facets of the issue, including the vulnerabilities of PLHIV households during such crises and the dynamics of funding for HIV advocacy, treatment, care and support programmes.

Symposium panelists pointed out that PLHIV households are pushed into a vicious cycle of poverty, debt and destitution as the crisis has forced them out of a job, reducing drastically their food consumption, and making treatment inaccessible to most of them. The relatively better off households, one of the speakers pointed out, are no better. This will have a significant impact on their health and life in the long term.

According to Dr. Debrework Zewdie, Director, Global HIV/AIDS Program, The World Bank, the overall funding for HIV/AIDS globally has increased from $ 4.2 billion in 2003 to $ 13.8 billion in 2008. Yet there is a gap of 40% between fund needs and availability. However, coverage has been much lower than 60%. This, she pointed out, amounts to inefficiency in the use of funds. Emphasizing on the need to enhance efficiency, Dr. Zewdie said that the squeeze due to the financial crisis could lead to treatment interruptions, causing increased mortality and morbidity if the available funds were not put to work efficiently.

Dr. Zewdie highlighted a World Bank study on the impact of the financial crisis on PLHIV who are on treatment in 71 countries covering 3.4 million people, which showed that over 50% of countries in the Asia Pacific would be affected in the next 12 months. 

Dr. Zewdie said: “There is a need to strengthen efficiency and cost effectiveness, particularly of HIV prevention efforts. There is also a need to develop an early warning system to track and minimize treatment interruptions and monitor the impact of economic crisis on a regular basis.” She emphasized that the key is to enhance efficiency of funds, show results, and highlight the impact of the funds spent for HIV. 

Caitlin Wiesen, HIV Practice Leader for Asia Pacific, UNDP, highlighted some of the core findings of the study, Impact of HIV on Households and Food Security, done by UNDP in Cambodia, Vietnam, China, Thailand and India. She pointed out that HIV affected households had reduced consumption expenditures that they would otherwise make for essential items by 37%. All households below the wealthiest quintile (80% of households) would fall below the poverty line as a result of the income and expenditure effects of HIV.

Detailing some of the policy interventions, Wiesen said: “Poverty and social safety nets need to prioritize HIV households with a range of micro-credit and financing schemes, medical and life insurance, and pension support. As seen from experience in Cambodia, food support programmes can be very effective, enabling PLHIV  households to invest in children’s education.” She also emphasized the need for longitudinal studies to provide valuable information on how the household economy changes as HIV progresses over time.

Among the key findings on the impact of financial crisis on migration are the need to strengthen the protection of rights and health of migrants and their families. HIV/AIDS, Wiesen pointed out, accounts for 0.01% of spending on stimulus packages. Detailing a rapid qualitative study recently done by UNDP in Surat, India, Pramod Kumar, Senior Program Advisor, UNDP, explained that even the relatively better off PLHIV households are severely hit by the global financial crisis. He said: “Since the economic crisis of 2008, nearly half of the 400,000 workers in Surat’s diamond industry have been laid off .The situation of the HIV-infected worker households is precarious with either no food or food reduced by 80% in most households. The situation of those on ART is pathetic”.

Shiba Phurailatpam, Regional Coordinator, APN+, explained that PLHIV in many pockets, particularly working in the export sector, are seriously affected by job cuts due to the impact of financial crisis. This has a serious bearing on treatment and care. On the other hand, there is a real fear that global funds for HIV are also going to be cut. “This affects PLHIV directly as funds for treatment in most countries of this region are donor dependent,” he said.

Phurailatpam warned that HIV prevention and care services are as it is under-funded and there is no room for further cuts. Social safety nets and stimulus packages should integrate HIV prevention, treatment and care to help them tide over the situation.

“Targeting of response is key and it could reduce people living with HIV in 2020 by 3.1 million,” said Ross McLeod, Consultant, ADB. Among the many responses he outlined are designing programs to minimize HIV incidence and contain treatment cost.

McLeod stressed on the need for accurate and timely data, especially for populations which are the drivers of the Asian HIV epidemic. “Containing cost”, he said, “enhances sustainability”. 

According to Jeff O’ Malley, Director, HIV AIDS practice, UNDP, there has to be a moral obligation to be efficient in the use of funds. Focus should be on the management systems and in the choice of interventions. He said: “PLHIV are disproportionately vulnerable and there is a need to make sure social intervention programmes are targeted at the most vulnerable households.”

SYNOPSIS:
Available evidence from the region and elsewhere indicates that the current global economic crisis is likely to have a significant impact on people living with HIV and their households. The loss of jobs, particularly in export and labour intensive sectors, and cutbacks in AIDS funding will have serious short term and long term impact on the health and wellbeing of people living with HIV. At the macro level, key prevention aspects of the national AIDS programmes and long term ART commitments are likely to be compromised by the sudden shortfalls in resources. Thousands of people could be pushed out of treatment and already vulnerable HIV households could be subjected to additional stress. The symposium will present and discuss emerging evidence on the issue from key studies of WB, ADB and UNDP, and provide government and PLHIV perspectives.

Chairs:
Dr. Christoph Benn, Director of External Relations and Partnerships, GFATM
Jeff O’Malley, Director, HIV/AIDS Practice, UNDP

Panelists:
Dr. Debrework Zewdie, Director, Global HIV/AIDS Programme, World Bank-  Findings from the global survey and implications for Asia and the Pacific
Ross Mcleod,  Consultant, ADB -  AIDS in Asia, Sustaining the Response in the Economic Crisis
Pramod Kumar/ Caitlin Wiesen, UNDP HIV Team -  Evidence from country studies on the vulnerability of HIV households
Shiba Phurailatpam, Coordinator, Regional Coordinator, APN+ - The impact of the economic crisis on people living with HIV and their households

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