Institute for War and Peace Reporting | Giving Voice, Driving Change

Concern About Future of Georgian HIV Funding

Tbilisi looking at ways of ensuring anti-retroviral therapy remains available for those who need it.
By Manana Vardiashvili

Dali, 40, has been living with HIV for the last ten years. Like all those with the virus in Georgia, she receives free anti-retroviral therapy (ART), paid for by the Global Fund to Fight AIDS, Tuberculosis and Malaria.

But ambiguity over the continued funding of the treatment has left Dali and her husband, who also has the virus, worried about the future. ART has turned HIV from a life-threatening condition into a chronic but manageable issue. The treatment is, however, expensive.

“I’m scared by the uncertainty,” Dali said. “My husband and I need around 3,000 US dollars a year just for the medicine. Although we both work, it’s hard to get together that kind of sum. And jobs don’t last for ever, particularly in Georgia.”

The Global Fund is to halt its funding of ART in Georgia from 2016, and Tbilisi has yet to decide how future treatment will be financed, although the health ministry has stressed that it was working on a strategy to minimise any disruption to patients’ treatment.

That reassurance doesn’t go far enough for Dali, however.

“The medicine which we take isn’t sold in ordinary chemists, since it isn’t registered in Georgia,” she continued. “Stopping the treatment would cost us our lives. The uncertainty is scary.”

According to statistics from the Infectious Diseases, AIDS and Clinical Immunology Research Centre in Tbilisi, Georgia has a relatively low level of HIV infection. The country had registered 4,413 cases of HIV infection by mid-July, of which 2,711 had developed full-blown AIDS and 944 had died. This year has seen 282 new diagnoses, with the majority of patients aged between 29 and 40.

Most experts think the true number of cases is around 6,000, with some 1,500 still undiagnosed.

ART first became available in Georgia in 1994 but owing to the high cost, it was only accessible to a handful of individuals. Since 2004, thanks to the Global Fund, all Georgians diagnosed with HIV have had access to the treatment. The Fund has spent around 40 million dollars on ART to date.

“At the moment 2,311 patients are undergoing ART, and their treatment is fully covered by the Global Fund,” said Tengiz Tsertsvadze, director of the Research Centre. “The state pays only for services around the treatment – for prophylactic work, communal services and the salaries of the medical staff. The treatment plans are chosen based on the recommendations of the World Health Programme. For ART, every patient needs 1,000-2,000 dollars each year, with the cost of the medicine depending on the stage of the disease.”

He said that properly conducted and begun in time, ART can not only extend a patients’ lives indefinitely but can also reduce the chance of them passing on the virus.

Because of the low level of HIV infection and Georgia’s relative prosperity, the Global Fund has removed Georgia from the list of countries where it will fund treatment from 2016. The health ministry has yet to draw up a plan to replace the funding.

“ART allows us to change it [HIV] from a deadly disease into a chronic medical condition,” said Lali Sharvadze, head of the dispensary at the Research Centre. “But halting treatment leads to rapid progression of the disease, and to death. HIV-positive patients require treatment for all their lives, which is very expensive.”

Tsertsvadze cautioned against panic, noting, “The Global Fund will finance HIV-positive patients until the end of 2015 – that’s guaranteed. The state has already begun talks with the [Global] Fund, and maybe it will reconsider its decision. It might be that the funding for Georgia will be reduced gradually. I hope the fund won’t halt funding in one go.”

A health ministry spokesman said that his department “has enough time to successfully complete talks with the fund and simultaneously create an effective plan for a national AIDS strategy”.

Lasha Zaalishvili, head of the Georgian Harm Reduction Network, told IWPR that – at the request of the Global Fund – civil society groups would join the discussions on creating a national strategy.

“There is already a strategic plan, though it is hard to call a document that contains just a wish-list a real strategic plan. In the new plan, which we’ll begin work on in September, there must be a detailed breakdown of the obligations the government is taking on, how much money is required to meet those obligations, and confirmation of the plan’s main goals,” Zaalishvili said.

The government will present the plan to the Global Fund in March next year.

Manana Vardiashvili works for Liberali magazine in Georgia.

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