Hundreds of thousands of people living with HIV in lower-middle-income countries, such as Indonesia, risk losing critical support when global charities pull funding from countries graduating to a higher income tier, the AIDS Healthcare Foundation said at a press conference on the sidelines of the 2018 Annual Meetings of the International Monetary Fund and the World Bank Group in Nusa Dua, Bali, on Thursday. (JG Photo/Sheany)

Indonesia at Risk of Losing Global HIV Support

OCTOBER 13, 2018

Nusa Dua. Hundreds of thousands of people living with HIV in lower-middle-income countries, such as Indonesia, risk losing critical support when global charities pull funding from countries graduating to a higher income tier, a global nonprofit warned on Thursday.

Income level, determined by the World Bank based solely on a country's per-capita gross national income, has become the main reference for aid allocation used by many charities focused on HIV support.

Countries often graduate to the upper-middle-income tier without a corresponding equal income distribution, nor robust health care systems in place. This is soon followed by charities shifting their focus from such countries, leaving many people living with HIV in those places without adequate support, as these countries do not yet provide affordable health care services of their own.

The AIDS Healthcare Foundation (AHF), a Los Angeles-based global nonprofit provider of HIV prevention services to more than a million people in 41 countries, has been advocating for raising the upper-middle-income threshold by three to five times the current standard, and including other metrics, such a country's disease burden, income gap and quality of life.

"We don't want the World Bank to use the arbitrary calculation anymore; we want a more cohesive consideration of all the factors in the country," Marie Ko, advocacy and marketing manager at AHF Asia, said on the sidelines of 2018 Annual Meeting of the International Monetary Fund and World Bank Group in Nusa Dua, Bali.

Indonesia, which currently sits on the higher end of the World Bank's lower-middle-income tier – a gross national income of between $996 and $3,895 per capita – is expected to soon graduate to the upper-middle-income tier.

The United Nations' AIDS prevention agency said in a statement that several donors have stated their intention to defund HIV programs in Indonesia once the country moves into the upper-middle-income tier.

This would leave an estimated 630,000 Indonesians living with HIV at risk.

Only 42 percent are believed to be aware of their HIV status and a meager 14 percent are receiving treatment for the disease. Even worse, foreign funding accounts for about 44 percent of the $100 million the country spends annually on treatment and prevention of the disease.

"We see this as a critical moment for Indonesia, once they lose the funding after becoming [an upper-middle-income country] they will have fewer resources to tackle the problems of HIV/AIDS," Ko said.

Riki Febrian, AHF Indonesia country program manager, said a lack of awareness of HIV/AIDS and current cost of treatment is one of the factors preventing people from having themselves tested for the disease, or from seeking treatment.

Despite ongoing government efforts to combat HIV and the national target of providing 81 percent of all people living with HIV with antiretroviral therapy by 2030, many programs led by civil society organizations to address the issue at the grassroots still heavily depend on external funding.

"We think it's unjust to a certain extent, because [countries such as] Indonesia will lose funding from, for example, the Global Fund, so how can they sustain their programs and cope up with the gaps?" Ko said, referring to the Global Fund to Fight AIDS, Tuberculosis and Malaria, an international financing organization that aims to attract, leverage and invest additional resources to end epidemics of these diseases around the world.

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