Durban - An airport tax and a transaction tax of a few cents for every credit card transaction are some of the ways in which African countries can fund their Aids responses, according to Health Director General Malebone Matsoso.
Speaking before the opening of the Aids 2016 conference, a wide range of global leaders voiced their fears that HIV might rebound in the last mile because of a lack of funds.
“I am scared because we are back in Durban in a different time, when the world is facing many competing challenges, including terrorism and migration,” said UNAIDS Executive Director Michel Sidibe.
“Thirteen of the 14 [main donor] countries have reduced their contribution to the Aids response. There is a risk of a rebound in the epidemic, and we will lose our investment, as we saw with malaria. We thought we had it under control but today we have to spend a lot of money again to bring it under control,” said Sidibe.
“I am scared because we are not seeing a decline in new adult infections, with about 1.9 million people infected every year for the past five years.”
He added that two million community health workers – about 200 000 in South Africa alone – needed to be trained to improve health services.
According to UNAIDS donor funding has declined to its lowest levels since 2010. “International donor contributions dropped from a peak of US$ 9.7 billion in 2013 to US$ 8.1 billion in 2015. Low- and middle-income countries are stepping up to fill the gap, with domestic resources accounting for 57% of the US$ 19.2 billion total funding in 2015.”
The current allocation of resources for HIV prevention was also falling far short of what is needed.
“Currently, 20% of global resources for HIV are being spent on HIV prevention. The report indicates that to have maximum impact funding should focus on the location and population approach in order to reach people at higher risk with combination prevention options where they live and work.”
But the idea of taxes is not a new one.
In 2012 at a previous Aids conference Rwanda and Uganda said they had begun to impose a levy on the use of mobile phones to fund health programmes, and Botswana, Gabon and Malawi, among others, had been investigating such a levy specifically for Aids financing.
Imposing a “sin tax” on alcohol and tobacco to pay for universal access to ARVs could be one of the most ambitious taxes to be implemented.
Emmanuelle Daviaud, a health economist and senior specialist scientist with the Medical Research Council, said that with the world’s economies in crisis we could expect funding for most research to dip.
“Some organisations are more circumspect and they believe that certain things should be done by the governments of the affected countries.”
South Africa, being a middle-income country, would also be expected to take on more of the burden.
She pointed out that the price of ARVs have decreased but because all people who test positive for HIV will now be taking ARVs (as outlined by the Department of Health in May) come September, despite their viral loads, it could get expensive.
“We need more detail: how much will be taxed? Will selected items be taxed? How will it work exactly? What will the funds be used for?”
ARV treatment is also regarded as being chronic, so people will be on the drugs for life.
Director of Caprisa Professor Salim Abdool Karim said given global fiscal constraints, funding for Aids was not growing at a pace that kept up with the need as both HIV treatment and prevention expanded.
"As a result, we need to use innovative approaches to fund Aids-related costs. The proposal to use something like a 'Robin Hood' tax on airline tickets, airport transactions, etc has been successful in some instances (eg. UNITAID) and could have great potential to raise badly needed funds."
United Nations Secretary General Ban Ki-Moon said access to treatment had increased 17 times to 17-million people since the last Aids conference in Durban in 2000, but there were still weaknesses,
“We need to close the gaps that keep people from accessing services, particularly for men who have sex with men, transgendered people, sex workers, injecting drug users and prisoners,” said Ban.
These “key populations” account for one-third of new infections globally.
Deputy President Cyril Ramaphosa said South Africa had “turned the tide dramatically against HIV since 2000” but HIV remained “stubbornly high” in young women aged 15 to 24.
Actress Charlize Theron said Aids was the biggest killer of adolescents in Africa and the number two killer of adolescents globally: “Our young people are dying at a rate that should frighten us,” said Theron.
“Until we reach young people and make them want better for themselves, we will not be able to end Aids. We will have to push the rock up the entire hill again, when we are so close to pushing it over the edge.”
Meanwhile, Treatment Action Campaign chairperson Nkhensani Mavasa praise government for significant progress in getting people on ARV treatment, but said “there are challenges of adherence and patients who are untraceable”.
She added that there was an urgent need to employ more community health workers to improve “the functioning of the health system”. She also appealed to UN leaders to “talk sense to African member states” who “criminalised key populations especially the LGBTI community” and saw civil society as the enemy.
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