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SA's 'suboptimal' fight against Aids costs it R5bn in US funding

The US plans to cut its funding for HIV treatment in South Africa by more than R5bn, saying the country’s fight against Aids is “grossly sub-optimal”, reports The Times. The US government, under the US President’s Emergency Plan for Aids Relief (PEPFAR), donated $750m – more than R10bn – to South Africa for the 2018/19 year. The current year under the funding began in October 2018 and ends in September. But, the report says, 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 South Africa 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 South Africa had quit their ARV treatment in 2018 than the number of newly diagnosed people who had started taking antiretrovirals.

The report says the letter about South Africa’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”. The report says at a clinic visit in Soweto, Birx said: “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. We are saying next year’s budget is only going to be $400m if things do not improve dramatically.”

This would mean South Africa would be getting about R5bn less in the upcoming year, at current exchange rates.

The report says 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.

Birx, who promised R1.2bn towards the South African 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 report says 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 South Africa would add another 2m people on treatment by 2020. But Birx said South Africa 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 (2m) is the minimum to put on treatment in order to decrease the number of infections,” said Birx.

According to the report, 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."

The report says Health Department spokesperson Popo Maja denied that its HIV response was “sub-optimal”. 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 sub-optimal 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 in the report that 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”.

The report says according to the District Health Barometer, which bases its reports on data provided by the  Health Department, South Africa has the largest antiretroviral treatment programme in the world. With about 7.9m people living with HIV in South Africa, data show that 4.1m people in the public sector were on treatment at the end of the 2017/18 period.

The rate for the number of people remaining on antiretroviral treatment in 2017/18 was 58.9% – up from 55.0% in 2016/17. Limpopo (72.6%), Northern Cape (71.1%), Free State (66.7%), KwaZulu-Natal (64.6%) and Mpumalanga (60.3%) had clients remaining on treatment above the national average of 58.9%.

The report says the lowest rate for clients remaining on antiretroviral treatment was reported by North West at 49.1%, Gauteng at 50.1% and Eastern Cape at 57.6%.

[link url=""]The Times report[/link]

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