U.S. Government Leading Backlash Against AIDS Funding

A few weeks ago, the Boston Globe published an article on the U.S. government’s decision to flatline AIDS funding in countries that are currently receiving money through the President’s Emergency Plan for AIDS Relief (PEPFAR). This flagship program has put 2.4 million people on treatment, restoring life and hope for millions.

Globally, more than four million people are currently receiving treatment, with support of PEPFAR, the Global Fund to Fight AIDS, Tuberculosis and Malaria, UNITAID, national governments, and other donors. But there are at least six million people who need treatment now, who are still unable to get it.

Instead of scaling up, now the Obama Administration is saying enough is enough. It is telling the health providers that it funds that they can only put new people on AIDS treatment if some of the people they are already treating die.

The Boston Globe article quotes Eric Goosby, the U.S. Global AIDS Coordinator, as saying “People are struggling to find resources to honor the commitments we have made… We’re not at a cap point yet. If it gets worse, we’ll have another discussion.”

Well, we just got our hands on a letter the U.S. government sent to treatment providers in Uganda in October, 2009. It says:

“In FY 2010 and 2011, each Partner should expect to have a set flat-lined budget for ARV procurement that should not be exceeded without discussion and written approval from their funding agencies. PEPFAR Implementing partners who directly provide antiretroviral treatment should only enroll new ART patients if they are sure that these new patients can continue to be supported without a future increase in funding...

“In filling treatment slots that are made empty through attrition – i.e. deaths and loss to follow-up estimated at 12-30% annually – priority should be given to the sickest patients, eligible pregnant women, children, TB/HIV patients, and family members of persons on ART. Partners should provide support as needed to ensure that patient information records are up to date and an equitable system of triage for total ART slots is worked out within their sites before enrolling any new patients.”

If that’s not a cap, then what is it?

Peter Mugyenyi, an AIDS specialist in Uganda, talked in that article about the anguish of turning people away: “Virtually every day, we have to turn away patients who need treatment, including breast-feeding women… We have to tell them ‘There is a freeze.’”

And at an event in DC on Monday as reported in the Science Speaks blog, Dr. Lydia Mungherera, a Ugandan medical doctor, activist, and woman living with HIV, said, “The hopelessness we had in the 1980s, when we had no treatment, is what we are going back to now… The basic issue of right to life is being disrupted.”

Sources on the ground tell us that as many as 800 people are being turned away from clinics in Uganda a month, with no other option but to go home and hope that somebody else who is already on treatment dies before they do.

Treatment is one of the single most important HIV prevention tools that we have. Much, much more needs to be invested in better and more effective prevention programs. But at the same time we know that treatment reduces infectivity and the availability of treatment encourages the uptake of voluntary HIV counseling and testing. According to the briefing report Will We End the HIV Epidemic? (download the PDF from the International AIDS Society website), simply treating all of the people who need treatment now would decrease new infections by as much as a third. When people know their HIV status, regardless of whether they are positive or negative, they are also more likely to take measures to protect themselves and others from HIV infection, whether that be by using condoms, reducing multiple partners, or not sharing needles.

Yet, the U.S. government’s decision to cap treatment is undermining the overall HIV/AIDS response in Uganda. As Mungherera put it: “Seventy percent of Ugandans don’t know their status. But what are we going to tell those people who come for testing? I’m sorry, there’s no treatment?”

The Boston Globe article made clear that it’s not just Uganda. The U.S. government has ordered a stop to building clinics in rural Mozambique and is starting to put limits on treatment in Zambia as well.

At the same time that the Obama Administration is flatlining PEPFAR funding, it is not doing anything more to make sure that it can leverage funding from other donors to help fill the gap. For every $1 that the United States gives to the Global Fund to Fight AIDS, Tuberculosis and Malaria, other donors give $2. Yet in its FY2011 budget, the Administration proposed to not just flatline, but cut, funding to the Global Fund as well.

And, as I’ve written before, other donor governments appear willing and ready to follow the U.S. government’s lead.

Don’t let it happen. Go to the International AIDS Society website where you can send a personalized email to President Obama and other G20 leaders, asking them to fully fund the Global Fund and keep their promise to universal access to AIDS treatment and prevention now.

10 Comments

This makes the puff piece that 60 minutes did recently on PEPFAR in Uganda even hollower!

This is a fantastic article. We are in the process of undertaking evidence based country commission inspections that will allow for further evidence on what is occurring on the ground, specifically UNAIDS Country Programmes. We hope that this will allow for further advocacy and policy on this issue. It is a grave issue and one that need further look into.

THIS IS SCARY!!! I cant imagine going back to the days prior to 2005, when only the rich could access ARVs...

This is very bad news news. People living with HIV/AIDS need the support that there is and this is a big blow to each of them and their families. But this again should highlight the disastrous failure of many African governments to help their people so that the right right to life makes meaning to them as it does to many citizens in developed countries. As much as it saddens me to hear Mr. Obama flat-lining ARV funding i must say that it is a shame for us in Africa to always look to other people for living with very little or no support at all from our own leaders. If our own governments were very concerned to look after their citizens more and better than the USA nobody would be sending comments like me here. I dont support Mr. Obama's move but you cant blame him much. Every country has its cross to bear for its people. Who thinks that the USA has to bear the cross of every person in every African country. I am tempted to think that even the most enlightened HIV/AIDS activists like Dr. Mungherera and others in countries that greatly rely on donor funding for ARVs may not understand me well because they feel that the USA "must hold on to its promises". But situations change and the recent credit crunch has done a lot to that effect.

What we need to say is: WAKE UP AFRICAN LEADERS. Get concerned about the people you lead. Where promises by the USA or others fail, be there for the people and you need to be there for them now after Mr. Obama's change of policy.

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One African leader just married the fourth wife. A Senator and ex Governor in Nigeria just married a 13 year old girl from Egypt. He reportedly payed 100,000 dollars to her parents. Some African leaders have billions of dollars in Western vaults and banks. Are we really ready for development of our people?

our hopes as africans are beginning to collapse. not only blaming the obama administration but what about those who set the millennium development goals. have they forgotten their promises. MDGs 4,5 and 6 will all be fundamentally affected.
cry the beloved africa.

This is the saddest news i have read all time.
i am in Agony with n. Mwanje and share the same belief with him.
Many Ugandans are heading back to the no treatment unless the government comes up with a strategy.
When i say government i also include us the citizens and policy makers.
But i will tell you one thing, i saw thing i saw this coming last year when the 1st cut on PEPFAR took place!!!
Again it makes me think that we should campaign for abstinence until marriage for those who are not married, Faithfulness to those that are relating and are yet to marry to avoid reinfection for those that are have HIV/AIDS.
As the famous advert in Uganda goes, togather lets put a stop to the spread of HIV/AIDS and we won't need the monies for treatment since we would have kicked HIV/AIDS out of our country.
Damon

our hopes as africans are beginning to collapse. not only blaming the obama administration but what about those who set the millennium development goals. have they forgotten their promises. MDGs 4,5 and 6 will all be fundamentally affected.

our hopes as africans are beginning to collapse. not only blaming the obama administration but what about those who set the millennium development goals. have they forgotten their promises. MDGs 4,5 and 6 will all be fundamentally affected.

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