by Chael Needle

On June 17, weeks after the U.S. announced that the President’s Emergency Plan for AIDS Relief (PEPFAR) would not significantly increase its funding to Africa, thousands of South African protesters marched on the U.S. consulate in Johannesburg.On June 17, weeks after the U.S. announced that the President’s Emergency Plan for AIDS Relief (PEPFAR) would not significantly increase its funding to Africa, thousands of South African protesters marched on the U.S. consulate in Johannesburg.

PEPFAR is a major funder for programs abroad, and South Africa, which has an estimated 5.7 million with HIV/AIDS, is the biggest recipient of PEPFAR funds.

But the protesters are advocating for all nations in need. The demand? That the U.S. increase its contribution to the Global Fund on AIDS, TB and Malaria to $2.8 billion by 2013. PEPFAR’s budget has only inched forward, increasing from $6.8 billion in 2010 to nearly $7 billion for 2011. The protesters also called on others from the international community to increase AIDS funding and for African nations to make good on earlier commitments to increase health spending to fifteen percent every year.

The protest drew the participation of a plethora of partner organizations that advocate for AIDS: The Treatment Action Campaign (TAC); Congress of South African Trade Unions; SECTION27, incorporating the AIDS Law Project; Doctors Without Borders; World AIDS Campaign; International Treatment Preparedness Coalition; AIDS Rights Alliance of Southern Africa; Community Media Trust; Southern African AIDS Information Dissemination Service; The AIDS Consortium; Rural Health Advocacy Project; Children’s Rights Centre; AIDS Response; Social Justice Coalition; Equal Education; and Bigshoes Foundation, along with other individual marchers. The U.S. released a statement reiterating its track record of commitment without mentioning the possibility of an increase.

Catherine Tomlinson, senior researcher at TAC, took the time to speak with A&U via e-mail.

How did the protests come about?
The protests came about because 2010 is the year that we are meant to meet universal access yet only forty-two percent of people in need are able to access antiretroviral treatment (ART). Yet, despite this, governments and funders are already beginning to backtrack on their commitments and reduce funding for ART and HIV programmes.

The United States government’s President’s Emergency Plan for AIDS Relief (PEPFAR) programme was a global leader in ART funding. But today, under the Obama administration, the U.S. is turning away from PEPFAR. The 2010 and 2011 budget requests for PEPFAR have kept AIDS funding the same when inflation is taken into account. Worse, they have decreased funding for ART.

The U.S. has also stated that PEPFAR will move away from providing “direct care” in favour of “technical assistance.” PEPFAR-funded programmes will struggle to provide ART and other HIV services if this happens. Many patients will go untreated and die.

There are already reports of PEPFAR programmes that are slowing down or even stopping enrollment onto ART. European Union countries are also threatening to reduce their AIDS funding. They too need to ensure that the Global Fund receives the $20 billion it needs.

How important are PEPFAR and other international funds to those affected by HIV/AIDS in South Africa?
PEPFAR is a large contributor to South Africa’s HIV/AIDS programme. PEPFAR contributors in 2009/10 were necessary to close the gap in terms of funding required to meet our targets of eighty percent access to ART by 2011.

Our concern is not confined to South Africa. Indeed, South Africa in contrast to other sub-Saharan African countries is better able to cover a significant part of the cost of AIDS, TB, and malaria treatment, prevention and care from our own fiscus [parliamentary voted funds]. But for historical reasons most developing countries are unable to finance the health needs of their population. The global AIDS epidemic has vividly illustrated this.
Nonetheless we fully agree that much more needs to be devoted from developing country budgets to health; that there is a need for ownership and responsibility for health programmes, better monitoring, evaluation, and efficiency.

However, at this point, removing patients from donor-funded care before developing countries have the capacity to absorb them will result in many patients going untreated and millions of avoidable deaths.

What are the effects, immediate and long-lasting, if AIDS funding does not keep pace with need?
Already we are seeing that programmes are capping enrollment and patients are being turned away from facilities without receiving care. We have also seen stock-outs, treatment rationing, and patients being forced to share regimens.

Over the long term, reduced funding will mean new patients will go untreated, leading to millions of avoidable deaths. At the same time a move away from providing ART will increase infant and maternal mortality and further fuel the tuberculosis and drug-resistant tuberculosis epidemics that are faced in the region.

Patients will also require intensive care for opportunistic infections and AIDS-related diseases which will increase the burden on healthcare systems and healthcare workers.

For more information about Treatment Action Campaign, log on to www.tac.org.za.

July 2010