"It has been very hard; we have tried to use our internal resources and prioritise interventions to make sure that we cover the most important activities," Dr Jean Rirangira, the interim executive secretary of the national AIDS control council, CNLS, told IRIN/PlusNews.
CNLS said the government had a shortfall of US$11 million of the $28 million required to fight the pandemic in 2008 as a result of the Global Fund rejection in November 2007, and there was a gap of $83 million to cover all the needs of the national AIDS strategic plan from 2007 to 2011.
"We have continued to buy ARVs [antiretrovirals] and train a few doctors, but our prevention efforts and attempts to help orphans and vulnerable children have suffered," Rirangira said.
Although the government and the Global Fund agreed that money from the fifth round of grants could be used over a two-year period to fill the funding gap, rather than the initial three years stipulated, the government has still had to tighten its belt.
"We had plans to expand services for prevention of mother-to-child transmission [PMTCT] of HIV, but we have had to postpone them till we get more funding," he added. "That sector is still very underdeveloped."
CNLS said over 500 health centres around the country offered antenatal services to pregnant women, but less than 20 percent of the clinics were able to offer PMTCT services.
"Our surveys estimate that, every year, between 15,000 and 18,000 HIV-positive mothers have children, but only about 1,000 of them benefit from PMTCT services," he said.
The country's health infrastructure was decimated by over a decade of conflict, but a shortage of funding has also slowed rebuilding the system and training health care workers.
According to Doctors of the World, an international health NGO, Burundi has one doctor for every 33,500 patients.
"Most of our doctors have moved to neighbouring countries or to Europe; we need to be able to offer health workers better packages to keep them in Burundi," Rirangira said.
NGOs also feel the pinch
Burundi has 12,000 people on ARVs, but almost twice as many need the drugs. NGOs have also had to rein in their spending and, in turn, their services to HIV-positive people. The Association Nationale de soutien aux Seropositifs et Sideens (ANSS), a Global Fund beneficiary, has been unable to take on additional patients this year.
"Access to ARVs is now limited to people whom we were already supplying, and their families," said Jeanne Gapiya, the founder of ANSS, the largest non-government provider of anti-AIDS treatment. More than 2,600 people receive ARVs from four ANSS centres around the country.
"In addition to drugs, if we wanted to maintain the quality of service that we provide, we would need to train and hire more doctors," she said. "Right now, our four doctors see 20 patients each per day and we don't want to overload them, so we cannot expand."
Gapiya said expansion would also entail training and hiring more community health workers to monitor families' health, adherence to drugs and psychosocial wellbeing.
According to Rirangira, the government has been notified that the Global Fund's Technical Review Panel has recommended that Burundi's application for funds from the eighth round of grants be accepted. The country has requested $150 million over a five-year period.
However, Nicolas Demey, media liaison for the Global Fund, told IRIN/PlusNews that the proposal still needed endorsement by the fund's board, due to meet in India in November, before it could be considered successful.
"We designed our eighth-round proposal to take into consideration our 2007-2011 strategic plan, because we still have not fulfilled all our aims," Rirangira said. "If we get the funding, all four areas will remain priorities, and we will strengthen PMTCT and prevention particularly."
He added that it was time Burundi began to look inward for funding, so that HIV programmes would be less affected by donor funding cuts and other external factors.
HIV prevalence in Burundi has been declining since the late 1990s, but many surveillance sites have recently indicated an upward trend; in May, officials announced that HIV infection had risen from 3.5 percent in 2002 to 4.2 percent in 2008.
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