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Washington Debates PEPFAR Funding Ahead of Global Fund Meet

Peter Boaz

WASHINGTON, Oct 2 2010 (IPS) - Global health advocates are strongly urging the Barack Obama administration to remain financially supportive of the fight against HIV/AIDS, amidst fears that economic prudence from the U.S. will reverse encouraging gains.

On Wednesday, the U.S. House of Representatives’ Committee on Foreign Affairs heard testimony from White House officials and NGO experts on the future of the President’s Emergency Plan for AIDS Relief, or PEPFAR.

The hearing comes ahead of a meeting next week at U.N. headquarters in New York where country representatives are expected to announce their financial commitments to the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Following a joint-UN agency report on the state of HIV/AIDS treatment and prevention released earlier this week, which showed a 17 percent reduction in HIV infections over the last eight years, activists warned that a drop-off in funding under President Barack Obama could jeopardise progress.

In May of this year, Obama unveiled his comprehensive global health strategy, known as the Global Health Initiative (GHI).

Faced with the current financial crisis, the GHI extends the previous five-year, 48 billion dollar PEPFAR programme by one year – but adds a mere 3 billion dollars.

Advocates, like Paula Akugizibwe, Advocacy Coordinator for the AIDS and Rights Alliance in South Africa, are disappointed in the administration’s apparent downgrading of HIV/AIDS as a health priority.

“HIV is not over-funded; rather, health is under-funded,” Akugizibwe told a committee hearing Wednesday in Washington.

“Shifting funding from HIV will not fill the yawning gaps in resources for health – this move is a cheap diversionary tactic that offers no genuine or long-lasting solutions for health systems,” Akugizibwe said.

But administration officials stress that incorporating PEPFAR into the GHI is a beneficial development.

“The metric that PEPFAR and all GHI programs use to measure success is not dollars spent, but lives saved,” said Eric Goosby, U.S. global AIDS coordinator, on Wednesday. “In order to save as many lives as possible, we have focused on making smart investments that maximize the human impact of each dollar.”

Goosby also emphasised expanding country ownership and local capacity to build sustainable health care delivery systems and optimise resources.

“PEPFAR’s support for country ownership is demonstrated through Partnership Frameworks, 15 of which have been signed,” he said. “These are five-year, high-level agreements between the U.S. and partner governments that leverage our investments to obtain measurable financial, programmatic and policy commitments to HIV and health systems.”

But Dr. Wafaa El-Sadr, who also testified on Wednesday, took aim at some of what she called the “myths and misunderstandings regarding PEPFAR [that] have gained surprising credibility.”

As the Director of the International Center for AIDS Care and Treatment Programs at Columbia University, El-Sadr told the Committee that it would be unwise to stray from PEPFAR’s original function.

“PEPFAR supports tens of thousands of programs and sites embedded within antenatal care programs and primary care settings at health centers, district andreferral hospitals,” she said. “Rather than reinventing the wheel, or starting from zero, we can build on this platform.”

At the heart of the PEPFAR controversy remains a reluctance of the Obama administration to commit billions of dollars in the midst of an economic recession.

Noting that the U.S. provided nearly 60 percent of donor government funding for HIV/AIDS last year, Goosby spoke of an approach that embraced working with partner governments, donor nations, the private sector, civil society, philanthropic organisations, and others.

Goosby continued that the U.S. is the largest donor to the Global Fund to Fight AIDS, Tuberculosis, and Malaria – having contributed more than 5.1 billion dollars to date.

Like nearly all global health advocates, Akugizibwe recognises the ground- breaking achievements that U.S. support has enabled in international health, but says “the current slackening of U.S. government financial commitment to HIV, rather than encouraging an invigorated response from other countries, is instead leading a regression back to the landscape where HIV was a death sentence.”

Akugizibwe cited a letter that Goosby wrote to civil society organisations, which read, “one country alone cannot respond to the unmet needs that are present, either globally or in any particular country… Every country must take a leadership role, including providing resources to the extent of its ability.”

The commitments that countries choose to make will be on display next week in New York.

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