Nobody likes waiting lists. No matter how polite and well behaved we may be, waiting for people to pay the bill and leave their table so we can finally sit down and eat is not fun. It’s just as annoying as having to hope enough passengers will not show up at the check-in desk so we can catch the last fully-booked flight home after an exhausting work trip.

Now imagine the waiting list is not in a restaurant or in an airport. Imagine you are not risking to delay your meal by a couple of hours or to spend the night in a hotel room. You are in a clinic, where you are waiting for a treatment without which you will most certainly get sick and die. And, what makes the process less boring, the more you wait the more the treatment risks to be ineffective.

The first question you would ask yourself is probably what the hell you are waiting for. And the answer would be so shocking you may wish you never knew it. You are waiting for some other patient to die.

Well, that is not exactly what HIV positive people waiting for treatment in one of the foreign-funded antiretroviral programmes in Africa will be told when their applications are turned down or they are put on a waiting list. But this is actually how the downscaling of these programmes - due to a shortage in funding - will work in many African countries.

In line with the targets of the Millennium Campaign, access to antiretroviral treatment (ART) should have become universal by 2010. This obviously did not happen, given the small percentage of HIV positive people enrolled in ART programmes in the developing world.

Not only the target was not met, but judging from some recent trends we may be moving towards the opposite direction.

The United States President’s Emergency Plan for HIV/Aids Relief (Pepfar) was the first to announce a flat-lining of its budget and ask recipient countries and health structures to limit the number of patients who are accepted in the ART programmes it supports. In other words, let some of them drop out (that is, wait until they die) before new ones can be accepted.

Pepfar claims to be “the largest effort by any nation to combat a single disease.”  And when this nation is the United States of America, one can easily understand how significant that effort must be.

If Pepfar suffers a crisis which forces it to limit its growth to a record low of 2.2 percent, other donors funding the fight against HIV/Aids are likely to be doing just as bad.

If we think of private foundations supporting ART programmes in Africa, The Global Fund to Fight Aids, Tuberculosis and Malaria is probably the first to come to our mind.  According to their figures, the foundation “provides a quarter of all international financing for AIDS globally.” Yet, it may be facing shortages up to $10 billion this year due to an increased demand.

Of course, donors had to put up with the consequences of the global financial downturn. They have to make their own calculations and decide what they will be able to afford. And if some African governments whose health systems are overwhelmed and under-funded are performing brilliantly in the ART programmes supported by external donors, maybe they should aim lower. In other words, you can’t even dream of improving the lives of so many people.

How cruel is that? And how cruel is that after governments and patients were given the illusion they would be fully supported in their fight against HIV/Aids? Now, how worrying is that considering that HIV/Aids is donors’ highest priority when it comes to health programmes in the African continent?

I am not a health expert, but I think aid policies and strategies should take into account the dignity of the people they target. And when you give your financial support to people and communities – including countries – who need it to survive, you cannot just take it back, or deny it from one day to the next based on budget issues.

When I was younger, I remember reading many newspaper articles on pharmaceutical firms enrolling African Aids patients in treatment programmes just to test their drugs. Patients would feel better and be grateful until the company reached its purpose and they were no longer needed. So treatment would just be suspended.

I have always found this scarce consideration of human lives very disturbing, but everybody knows major pharmaceutical companies are the bad guys. They play with patents and prices to get richer and richer while people in poor countries don’t have access to life-saving treatments.

To my knowledge  – if we exclude some controversial episodes – donors do not adopt the same opportunistic strategies based on using needy patients only to abandon them when they are no longer useful. It would not make sense.

There is something disturbing, though, in asking governments and health clinics in Africa not to treat too many patients. After all we are talking about a disease which has claimed so many victims in the developing world that a reverse of its spread is considered as necessary by the UN in order to achieve the Millennium Development Goals.