“Treatment scale-down ahead? Rationing the HIV response in the shadow of success” outlines examples of gaps MSF teams observe in a subset of countries where we work (Malawi, Mozambique, Zimbabwe, Central African Republic and Guinea).

National HIV programmes are facing critical challenges to sustain and scale up lifesaving services amid the threat of declining international funding.

The briefing note reflects on the trend of stagnating international funding coupled with rising and often unrealistic expectations on countries with large unmet needs and limited capacity to fund their response.

Unless these trends are reversed the common image of people leading healthy lives with HIV might quickly be replaced by severely ill patients, on the verge of death.

With low ARV coverage and breakdown of prevention measures, transmission and AIDS-related deaths will continue unchecked.