At a Congressional briefing today, AIDS experts expressed grave concern about a shift in the focus of the US President’s Emergency Plan for AIDS Relief, from providing HIV treatment to patients to providing technical assistance to developing country governments. The policy shift comes hand-in-hand with a pull-back from funding targets authorized in the Lantos-Hyde Act, which reauthorized PEPFAR.
These policies are leading to disturbing trends on the ground, including HIV-infected patients being denied access to lifesaving drugs in Uganda and elsewhere, emergency stock-outs of antiretroviral drugs, rising concerns about the emergence of HIV resistance, and patients being “dumped” into the hands of ill-equipped government health facilities.
Much of the focus of the briefing, attended by key House staff members and a dozen or so HIV advocates, was on Uganda, which was featured prominently in a front-page New York Times story today about the devastating implications of stagnant funding for global AIDS programs.
“Uganda is the tip of the iceberg,” said Sharonann Lynch, of Doctors Without Borders. “You absolutely cannot ration care at this point… It’s throwing the last ten years of clinical practice out the window. What we’re seeing on the ground now is worse than six months ago. So what’s it going to be like six months for now?”
She said members of Congress need to ask the Obama Administration, including top officials at the Office of the Global AIDS Coordinator, pointed questions about their commitment to HIV treatment.
“How many new treatment slots will there be in 2010? How many new treatment slots will there be in 2011?” she asked.
Lynch noted that in several countries, such as the Democratic Republic of Congo, there are reports of PEPFAR redirecting money from treatment, i.e. purchasing ARVs, to providing training and technical assistance. That is devastating to developing country health systems, which are not equipped to take on the burden of AIDS treatment programs.
“It’s a radical shift in policy,” Lynch said. “PEPFAR had been filling the empty medicine cabinet, and technical assistance can only go so far. You can’t keep someone alive” if there are no drugs to treat their disease. She said there needs to be pressure on OGAC to get back to the business of saving lives and pursuing bold treatment targets.
Asia Russell, of Health GAP, said that OGAC officials initially told concerned activists that they could expand treatment, despite the limited funding, to more than 4 million people by finding cost savings in its current programs. But she learned on a recent trip to Uganda that implementers are being told that they cannot use any money saved through program efficiencies to add new treatment slots. She noted that creates a perverse disincentive to run efficient programs.
She said this policy seemed to be driven by the Office of Management and Budget, not OGAC. “They’re in the caboose,” she said of OGAC.
Russell said another problematic development in Uganda is that providers had once worked very closely with the public sector, sharing information and resources. But that’s not happening anymore, as treatment is being capped and patients are being steered toward ill-equipped government-run clinics.
Pearl-Alice Marsh, with the House Committee on Foreign Affairs, said she feared that the policy shift was intended to transfer programs to developing countries in a “very short period of time” and this new policy means less of a focus on bending the curve of the epidemic. But “we’re not out of the emergency phase” when it comes to AIDS.