US cuts R5bn off funding for SA’s ‘suboptimal’ HIV scheme
Wake-up call as US finds fundamental problems with HIV programme despite massive funding for treatment
The US plans to cut its funding for HIV treatment in SA by more than R5bn, saying the country’s fight against Aids is “grossly suboptimal”.
The US government, under the US President’s Emergency Plan for Aids Relief (Pepfar), donated $750m – more than R10bn – to SA for the 2018/19 year. The current year under the funding began in October 2018 and ends in September. But only $400m (about R5.7bn) is on the table for 2019 to 2020. US Global Aids co-ordinator Dr Deborah Birx is on a two-week tour of SA and neighbouring states, meeting with government officials and health organisations.
In a scathing Pepfar letter ahead of Birx’s trip, US officials expressed their disappointment that more people in SA had quit their ARV treatment in 2018 than the number of newly diagnosed people who had started taking antiretrovirals. The letter about SA’s 2019/20 funding said: “Despite a significant infusion of resources by the US government, especially over the last three years, progress has been grossly suboptimal and insufficient to reach epidemic control.” It spoke of “several fundamental problems” with the Pepfar HIV treatment programme. Birx called the letter a “wake-up call”.
At a clinic visit in Soweto, Birx told Times Select: “There is already $750m here [for Oct 2017-Sept 2018]. We are not taking it back. But we are saying next year’s budget is only going to be $400m if things do not improve dramatically”.
This would mean SA would be getting about R5bn less in the upcoming year, at current exchange rates.
Birx is not happy with the number of people who start taking antiretrovirals but then appear to stop treatment. Reasons for this – given by her and the national health department – are long waiting times at clinics, perceived negative attitudes from nurses, and teenagers feeling judged when they ask for ARVs or contraceptives. But Birx, who promised R1.2bn towards the SA Aids response during last year’s December Global Citizen concert, defended the decision to cut the funding, saying it would not make a difference on the ground. “It’s funding you at your level of achievement, since that is the level of achievement we have seen. So it’s not about taking money away, it is fully funding the programme being executed now. Because the execution is not happening.”
The letter explained that the country had not met targets to find HIV-positive people through testing and encourage them to start treatment. If enough people are on treatment correctly and consistently, they become non-infectious and the rate of new infections should go down.
In February 2018, President Cyril Ramaphosa said SA would add another two million people on treatment by 2020. But Birx said SA had not met those targets. She said the programme had to speed up to reduce new infections.
“That is the minimum, I just want to be very clear, and that [two million] is the minimum to put on treatment in order to decrease the number of infections,” said Birx.
She said seven countries funded by the US received the seriously worded letters. “We use data to guide us, because it’s impartial. It sees through our perceptions of how we think we’re doing, to the reality of how we are truly doing."
Health department spokesperson Popo Maja denied that its HIV response was “suboptimal”. He said the department was aware that some people were not staying on treatment. In March 2018 it sent teams to the busiest 220 clinics to try to resolve the problem.
“We don’t view it as a suboptimal response as such. Rather we expected that some unintended outcomes for such a huge programme will occur. For example, the more people are on treatment, the more you will have the likelihood of a higher number of defaulters. What matters then is what we do about such unintended outcomes.”
He said some patients stopped taking medicines because they had “treatment fatigue”. He agreed that there were discouragingly long waiting times “as 600,000 new patients are added on the ARV programme every year”.
Maja said the department had been trying to stop people defaulting on treatment. “We have been strengthening the information system within facilities, ensuring that patients are contacted when they miss their clinic appointments or fail to pick up their medicines.”
He said “community health workers will be allocated a quota of patients to follow up each week”.