Six years ago the UK government made an important reversal in its policy towards HIV/AIDS treatment. Whereas previously the UK approach was to fund the building of general health care infrastructure, Hilary Benn, the then development secretary, announced that supporting drug treatment for the millions infected by HIV/AIDS in Africa was a priority. “We should have done more sooner, and we could all be doing more now,” he said.

Extraordinary progress has been made since then. Thanks largely to the support of international donors, notably the US and the UK, the number of people living with HIV/AIDS in the developing world who now receive life-saving antiretroviral treatment has increased 10-fold in the last five years. There are also signs that global incidence has peaked, giving some cause to hope that the worst of this epidemic, that last year alone claimed 2 million lives, is over.

The UK government was right to recognise that HIV/AIDS deserved specific attention, and by urgently focusing resources on a single leading killer disease, helped to catalyse national HIV/AIDS treatment programmes. To deliver antiretroviral treatment correctly, clinics and hospitals had to be built and refurbished, health workers had to be trained, drug delivery systems needed to be established. Anecdotes of mis-prioritisation can always be found, but research carried out by the World Health Organization and others found that overall HIV programmes have broadly benefited health systems.

Today, however, the global fight against HIV/AIDS is losing momentum. The economic crisis is forcing Western governments to rethink the amount of money they spend on the health problems of the developing world. “Issue” fatigue is allowing AIDS to be displaced by other important global concerns, most notably climate change.  Within the global health community, there are worrying signs of a u-turn back to the pre-2003 logic that money for AIDS should instead go towards building health care infrastructure.

In Uganda, the US government announced that funding will not be made available to treat new patients, and patients are beginning to be turned away from clinics.  Other donors are also indicating a shift away from HIV/AIDS. The UK recently pledged to continue HIV funding over the next five years, but how much will go towards treatment remains obscure.

Health workers in southern Africa are painfully aware that the battle is far from won. At least six million HIV-positive people require antiretroviral treatment today but do not have access to it, and the consequences of this unmet need continue to be reflected in horrific death rates. HIV/AIDS is the leading cause of mortality among women of child-bearing age worldwide; 80% of all deaths in Botswana and two-thirds of all deaths in Lesotho, Swaziland, and Zimbabwe are due to AIDS

Six years ago, the UK government provided leadership to the G8 by resolutely committing to funding treatment. In 2005, the UK government pushed its fellow G8 members to commit to a goal of providing universal access to treatment by 2010 – a commitment we will certainly fail to meet.  As the international community waivers about how best to serve global health, the UK government could again lead the way by reaffirming its commitment to people with HIV/AIDS while providing increased support for other neglected health problems.

Meanwhile, as Western donors prevaricate, African countries, which were pressed by the international community to do more for AIDS, now must wait to see if they will continue to receive the support they were promised. And health workers warn about early signs of a return to the desperate past, when they had to ration a simple and cost-effective life-saving medicine, and in so doing make the impossible choice of who lives and who dies.

Nathan Ford is Head of the Medical Unit, Médecins Sans Frontières, South Africa