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South Africa faces HIV funding test with shift in PEPFAR money

With PEPFAR planning to shift about $100 million in HIV funding from South Africa to poorer countries, the New York Times reports, the country will face stern challenges in maintaining its AIDS effort.

In 2013 South Africa got $350 million in PEPFAR backing, much of it going to workhorse private clinics. By 2016, though, PEPFAR plans to slice $100 million from South Africa’s HIV budget. “We need to move on to places like Burundi and Cameroon,” former PEPFAR chief Eric Goosby told the Times.

That means, for example, that Ian Sanne’s Right to Care clinics, founded in 2004 entirely with PEPFAR backing, will need money from South Africa’s government or other backers to care for its 203,000 HIV patients in five provinces.

When one Durban hospital abruptly closed after its PEPFAR grant ran out, the Times reports, it told 4000 HIV patients to continue care at public clinics. But a survey found that 800 of those 4000 people—20%—stopped filling their antiretroviral prescriptions. If the same dropout rate holds true for the estimated 1 million South Africans supported through PEPFAR grants, 200,000 people will stop care.

Heavily used public HIV clinics already have a hard time keeping up with the patients they have, according to the Times. And because of high HIV prevalence in South Africa—6 million by one estimate—the country faces drug shortages. A survey by the health advocacy group Section 27 found that 20% of the country’s pharmacies sometimes run short of HIV and TB drugs.

But South African health minister Aaron Motsoaledi assured the Times that the country can meet its HIV funding challenge. If we do not treat people with HIV, “we make TB worse, cervical cancer goes up, even leprosy returns,” Motsoaledi explained. “From whatever angle you look at, it’s cheaper to treat people [with HIV] early. The treasury minister understands that. It’s becoming easy for him to agree.”

Donald G. McNeil Jr. AIDS progress in South Africa is in peril. New York Times. 25 August 2014.


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