Here are a few articles that have caught my attention this week, focusing on some emerging analysis about the implications for President Obama’s re-vamp of PEPFAR and reduced commitments to the Global Fund:
· A Boston Globe story from early April, which highlighted fears from HIV/AIDS treatment advocates that funding under Obama’s recent re-authorization and re-vamping of the Presidential Emergency Plan for AIDS Relief (PEPFAR) was squeezing funding for treatment, got further attention from Newsweek, which said: “AIDS advocates are now wondering whether “pragmatic” is just a euphemism for cheap”. The quote was referring to PEPFAR’s new focus on systems-strengthening programs and its Global Health Initiative, which are supposed to channel funding to smarter, more holistic programs, bit which practically provide very little more funding for a whole lot more work.
· Shannon Kowalski at Open Society Institute got her hands on a letter from the US Government to Ugandan treatment providers which laid out expectations for “flat-lined budgets” for ARV procurement. Her comment to Eric Goosby’s (US Global AIDS Coordinator) statement that “we’re not at a cap point yet”: “If that’s not a cap, then what is it?” Jina Moore at Change.org re-interpreted the letter to point out what it’s really saying: “We’re not giving you money to enroll new patients. When patients die, new ones can take their place.”
· A group of scientists, clinicians and educators sent a letter to the Senate Sub-committee on Foreign Operations stating that “A crisis in access to HIV treatment is brewing again in Africa as a result of the worldwide recession, flat funding for PEPFAR, and a shortfall in funding for the Global Fund”. The letter went on to urge “an appropriation in fiscal year 2011 … that allows for a significant scale-up of HIV prevention and treatment and TB control”.
· The implications for this are made most apparent by a recent report released by the International AIDS Society entitled “Will We End the HIV Epidemic?” which makes the solid case that treatment is, in fact, preventative – ARV therapy is being used to prevent vertical transmission (transmission from mothers to babies), it leads to a 90% decrease in transmission between heterosexual discordant couples (where one is HIV+ and the other HIV-) and treatment scale-up can lead to declines in HIV prevalence at the population level.
Personally, as someone working on the ground in sub-Saharan Africa, where my hard-working, healthy colleagues living with HIV are testament to the sea-change that has been caused by increased access to treatment, this analysis is deeply troubling.
