While the G8 is putting maternal health at the top of its agenda for next month's summit, fears are growing that the club of wealthy nations is neglecting one of the biggest killers of women: AIDS.
Many of the biggest Western donors are freezing or reducing their budgets for AIDS treatment, leaving nine million people at growing risk of death because they cannot get medicine, including six million in Africa alone, activists say.
A study in The Lancet last month estimated that AIDS is responsible for 61,000 of the 350,000 annual deaths worldwide of women in childbirth or pregnancy. The impact is harshest in Africa, causing a rise in maternal deaths in eastern and southern Africa even as most other parts of the world are seeing a decline.
Women with the AIDS virus are at much greater risk of weakening and dying in pregnancy and childbirth, when their immune system is already low. A study this year found that HIV-positive women in Zimbabwe, for example, have a far higher risk of dying within two years of childbirth, compared to other women. In fact, HIV/AIDS is the biggest cause of maternal death in many African countries.
Despite the G8's new focus on maternal health, its leaders seem unaware of the impact of AIDS on women and are backtracking on the G8's earlier pledges of universal access to life-saving medicine, critics say.
"What's being proposed is to take resources from HIV and give them to maternal health, but you cannot separate the two, because it's the same patient," said Mit Philips, health policy analyst at Médecins Sans Frontières.
"Donors seem to be losing interest in the fight against AIDS," she said. "There are early, but clear, signs of donor retreat. We're extremely worried by this. We already have a huge treatment gap, and this will only widen the gap."
Most African countries are heavily dependent on foreign funds for the vast majority of their AIDS medicine. But after years of progress in the fight against the disease, those gains are now being reversed, MSF said.
In a study released on Thursday in Johannesburg, MSF found mounting evidence of drug shortages in the eight African countries that it studied. In some countries clinics are turning away AIDS patients, and there are increasing disruptions in supply.
In Congo, for example, the study found that the number of new AIDS patients able to get treatment has fallen by more than 80 per cent. Declines have also been recorded in Uganda and South Africa. And MSF itself has been asked to step in to provide emergency drug supplies in Malawi, Zimbabwe, Congo, Uganda and Kenya.
"As an HIV patient, this makes me feel very worried and vulnerable," said Jimmy Gideyi, a 55-year-old Kenyan widower who has survived with HIV for the past six years because of the anti-retroviral drugs that he is receiving.
"I don't think the donors really understand what is at stake," he said. "It will mean the end of life for many people in Kenya, in Africa and in the developing world. Ultimately, we shall die."
Eric Goemaere, medical co-ordinator for MSF in South Africa, recalled the early days of AIDS treatment in Africa, when most patients were brought in to clinics on stretchers because they were too weak to stand up. Doctors had to stabilize the patients before their treatment could even begin. When drugs became more widely available, most patients were healthy enough to walk in to the clinics on their own - but these gains will disappear if donors continue to cut back, he said.
The best medicine is available to AIDS patients in wealthy nations, yet there are growing shortages of crucial drugs in the poorer nations, Dr. Goemaere said. "Are we going back to a double standard of care?" he asked. "If this trend is confirmed, I'd call it a moral betrayal."
While donors are capping or reducing their funds for AIDS, the number of people needing medicine has increased sharply as new guidelines for treatment are introduced. Across the world, barely one-third of the 14 million people with HIV have access to the medicine they need.
"In countries with high HIV rates, you can't do anything to improve maternal health unless you tackle HIV," Ms. Philips said.
Julio Montaner, a Vancouver scientist who heads the International AIDS Society, said the AIDS virus is still the leading global killer of women of reproductive age. In many African countries, about 30 per cent of women of reproductive age have the virus, he said.
"There will be no success in maternal and child health unless the G8 delivers on HIV/AIDS treatment," he said.
"We have fallen short on our pledges to achieve universal access by 2010. Before we embrace new programs, we need to ensure that the G8 delivers on old pledges. Failure to do so will badly erode the credibility of the G8 and, more importantly, it will preclude the success of any new health initiative."Report Typo/Error