Boston Globe examines how PEPFAR budget pressures are affecting AIDS clinics in Africa

Apr 13 2010

"U.S. officials have asked some AIDS clinics overseas to stop enrolling new patients in a U.S.-sponsored program that provides lifesaving antiretroviral drugs, in a bid to stem the rising costs of one of the most ambitious US assistance programs, according to interviews with doctors and official correspondence," the Boston Globe reports.

While "Obama administration officials say they are not capping the number of patients receiving antiretroviral drugs … they acknowledge that they are seeking to control the ever-rising costs of the program, known as the President's Emergency Plan for AIDS Relief [PEPFAR], which has grown from $2.3 billion in 2004 to nearly $7 billion this year," the newspaper writes.

The article examines the effects of budget pressures on HIV/AIDS clinics in Africa, including several in Uganda that received a memo last October stating the following, according to the Boston Globe: "'The U.S. government recognizes that in the coming years, the number of patients in need of antiretroviral treatment will increase dramatically,' it read. 'While the US government is committed to continuing treatment for those individuals already enrolled . . . funding for HIV programs is not expected to increase in the near future. As a result, PEPFAR Uganda cannot continue to support scale up of antiretroviral treatment without a plan from the Government of Uganda on how these patients will be sustained.'"

Health GAP's Asia Russell said, "Basically, they are telling families, including kids who want to test for HIV, that if you test positive, you are going to have to sit on a waiting list for months and we can't give you any assurance that you will ever get the drugs you need."

Ambassador Eric Goosby, U.S. global AIDS coordinator, "said the letter merely asked clinics not to exceed their agreed-upon budgets and he said thousands of new patients continued to be enrolled each month in Uganda in 2009. But he acknowledged that the funds do not meet the need," according to the newspaper.

"In Obama's first year, the growth of funding for the AIDS program slowed," the newspaper continues. "Obama campaigned on a pledge to add $1 billion a year, but asked Congress for an increase of only $366 million for 2010 because of the recession. That has pushed thousands of people onto waiting lists for the drugs, including children, according to interviews with more than two dozen health care providers across Africa." 

Still, "Goosby said the administration is committed to nearly doubling the number of patients receiving drugs, to at least 4 million by 2014" and that "Obama will request an additional $15 billion for his own global health initiative aimed at enabling HIV clinics to treat other diseases, such as diabetes, as well as providing HIV capabilities to facilities that don't currently have them," according to the Boston Globe. Goosby "outlined simultaneous, aggressive measures to cut costs, which included the eventual transfer of responsibility for AIDS treatment to the patients' own governments; consolidating clinics, rather than opening more; and treating the sickest patients first."

According to the newspaper, "Goosby signaled strongly that the United States will not push to implement the new [WHO HIV treatment] guidelines" that would start treatments earlier "because that would triple the number of people eligible to receive the drugs and greatly increase costs" (Stockman, 4/11).