Speaking Out

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Fri Aug 13, 2010

The United States’ Turnaround on AIDS Funding for Uganda; Good, but Not Enough

By Sohaila Abdulali

HIV/AIDS service providers in Uganda can stop turning away people who arrive at their doorsteps desperate for life-saving medicine. For the moment. 

PEPFAR, the President’s Emergency Plan for AIDS Relief started by George Bush in 2003, has restored enough funding to lift the restriction that meant one person had to die in order for another to get AIDS drugs. This was the grim scenario when the US government announced that funding will not be increasing even as an additional 110,000 Ugandans are infected each year. Of the 500,000 who need treatment right now, less than half are getting it.

This is good news for Uganda, and good publicity for the US, but it does not change the fact that overall PEPFAR funding has not increased under the Obama administration despite the President’s campaign promises to the contrary. Other countries will soon be in the same terrible position of waiting for people to die so that others can get treated.  

From 2003 to 2009, PEPFAR funds are estimated to have saved 3.28 million adult years of life. This is a phenomenal accomplishment. Putting curbs on AIDS funding is never sensible or humane, but now is a particularly bad time. Countries including the US have committed to making 2010 the year of  “universal access” (defined as access to treatment by 80% of infected people, so literally quite a long way from universal), but less than half of those who need it are able to get antiretroviral treatment. This despite the fact that treatment costs have plummeted. South Africa, the biggest recipient of PEPFAR funds, is finally ready, after years of misguided thinking and planning, to tackle HIV in a comprehensive, intelligent way, but it will not be able to do this if funds don’t match the trajectory of the pandemic. 

The AIDS community has come to see the wisdom of the concept of “treatment as prevention”—the more infected people on treatment, the slower the spread of the virus. Add to this the fact that withholding treatment to save money now simply means more very sick people later, and flat-lining funding in the name of economics starts to look increasingly absurd. 15 million people in low and middle-income countries need drugs now, according to the latest WHO treatment guidelines. But only 5.2 million are getting them. 

From the beginning of the pandemic, every significant step in prevention, treatment and care has come about because of the tireless efforts of activists advocating for change. As soon as the U.S. announced that there would be no significant increase in PEPFAR funds this year, activists everywhere mobilized. They marched in Johannesburg. They spoke to the global media. They protested at the International AIDS Conference in Vienna. And, bowing to pressure, the US reversed its policy in Uganda. But nobody in Tanzania, Malawi, Vietnam or anywhere else should have to be turned away and sent home to die of AIDS for lack of drugs. President Obama must keep his promise, and the US must keep its commitments. There is no justification, economic, moral or practical, for doing otherwise.