Burundi is not the first African country to run short of antiretroviral drugs and it is unlikely to be the last. Apparently, the shortage has already been blamed for 20 deaths. Only just over 40% of Burundians in need of the drugs are currently receiving them. In addition to sickness and death, shortages of the drugs can give rise to resistance to the only antiretrovirals that are affordable to Africans.
The shortage is attributed to a serious drop in donor funding. But even a change in emphasis in donor funding could have a similar effect, for example, if it were decided that PrEP for HIV negative people could compete with ARVs for HIV positive people in the race for funding.
Meanwhile, other research shows that earlier treatment may result in reductions in HIV transmission. The claims made about the effectiveness of earlier treatment (and more people treated) are controversial because they are based on a best case scenario. However, pharmaceutical industry mouthpieces such as AVAC are playing down any possible worries that may be raised by a fairly compliant HIV industry, led by UNAIDS.
According to the head of UNAIDS, Michel Sidibe, 'treatment is prevention', a favored soundbite of the industries that stand to profit most from the HIV pandemic. Which competing interests will be benefiting from dwindling funds is not clear, though it is unlikely that any of the current beneficiaries will be any less well off.
Interestingly, the EU is busily trying to scupper any chance that drugs, formerly unaffordable to everyone, still unaffordable to those in high prevalence countries, might one day be priced at a level that can allow all those who need them to afford them. The EU wants India, the producer of the cheapest generic drugs, to sign an agreement that will prevent them from continuing to do so.
Sidibe also makes a common claim about HIV funding, which dwarfs funding for all other health areas in developing countries: he tries to include other diseases such as TB along with HIV as a possible target of the funding. However, there is a serious TB epidemic in many African countries that is quite separate from HIV, though the two overlap somewhat.
TB is another disease where drug resistance is a very serious problem, probably because it is targeted in relative isolation from other diseases and from the conditions that give rise to serious epidemics and health problems. But it also makes a lot of money for the pharmaceutical industry and is likely to be a significant cash cow in the future.
I guess we should never expect public money for health or human rights to be prioritized over the need of multinationals to increase their profits at all costs.