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 2018/2019 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 2019/2020.
US Global Aids co-ordinator Dr Deborah Birx is on a twoweek tour of SA and neighbouring states, holding meetings 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 antiretroviral treatment in 2018 than the number of newly diagnosed people who had started taking them.
The letter about the 2019/ 2020 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 said the letter was a wake-up call.
At a visit to a clinic in Soweto, Birx said: “There is already $750m here [for October 2017September 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, at current exchange rates.
Birx is not happy with the number of people who start taking antiretrovirals but then stop treatment. Reasons for this – given by her and the national health department – are long waiting times at clinics, the perceived negative attitudes of nurses, and teenagers feeling judged when they ask for antiretrovirals or contraceptives.
But Birx 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 SA had not met targets to find HIVpositive people through testing and encourage them to start treatment.
If enough people are on treatment correctly, they become noninfectious and the rate of new infections should go down. In February 2018, President Cyril Ramaphosa said SA would add a further two-million people on treatment by 2020.
But Birx said that target had not been met.
She said the programme had to speed up to reduce new infections.
“That is the minimum to put on treatment to decrease the number of infections.”
She said seven countries funded by the US had received the seriously worded letters.
“We use data to guide us, because it’s impartial.”
Health department spokesperson Popo Maja denied its HIV response was suboptimal.
He said the department was aware that some people were not staying on treatment.
In March 2018, it had 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,” Maja said.
“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, ensuring that patients are contacted when they miss their clinic appointments or fail to pick up their medicines.”
Community health workers would be allocated a quota of patients to follow up on each week, he said.