Action Needed on PEPFAR: Update from Uganda

While in Uganda last week I met with PHR Health Action AIDS Advisor Dr. Peter Mugyenyi, the Director of the Joint Clinical Research Centre (JCRC), which provides care to thousands of people living with HIV/AIDS. You may remember that Dr. Mugyenyi was in DC in March with PHR to provide an update on the impact of PEPFAR (the President's Emergency Plan for AIDS Relief) in Uganda and highlight the importance of continued robust funding to meet the needs of people living with HIV in Sub-Saharan Africa.During his visit, Dr. Mugyenyi described the dire situation facing many HIV patients in Uganda. I learned on my recent trip that the situation has not improved. Dr. Mugyenyi remains extremely concerned about the fate of the 150,000 people living with HIV/AIDS in Uganda who are currently on treatment.Funding for PEPFAR-implementing partners like JCRC in Uganda was flat this year, instead of being scaled up as is needed and was expected after the 2008 reauthorization of PEPFAR. JCRC, which is providing AIDS treatment to more than 40,000 people, has no guarantee of funding after September 2009. Current contracts for treatment have yet to be negotiated due to the rebidding process for the new PEPFAR. If the contracts are not settled quickly, organizations like JCRC, which have successfully scaled up care and treatment services for thousands of HIV/AIDS patients over the past five years, will have to drastically cut their services in the next few months.With the flat-lining of the budget this year and the growing fear that there will be no new PEPFAR funding in the next fiscal year, JCRC has already been forced to make difficult decisions regarding patient care. Dr. Mugenyi has implemented new cost-cutting measures for all JCRC sites. For example, a new triage system for HIV-positive patients puts only the most critical cases on treatment, as opposed to offering treatment to all those who qualify based on the progression of their HIV disease. Such a system is contrary to the current standard of care for HIV, but it is the only way for JCRC to ensure that medications are available for the most critically ill.Dr. Mugyenyi is also ordering cheaper medicines – some with increased side effects – in order to save money and ensure enough medicines are available. And, JCRC is limiting the quantities of medications that patients can take away with them on each clinic visit in order to ration dwindling supplies. For those living in remote or rural areas, this will add an additional obstacle that may very well be the difference between life and death.With a reduction in funding, JCRC runs the real risk of staff layoffs that will further complicate and reduce PEPFAR’s ability to address Uganda’s HIV/AIDS crisis. Fewer staff means fewer HIV screenings, fewer CD4 tests, less monitoring of opportunistic conditions, and a weakened health system less capable of addressing HIV/AIDS and other endemic health conditions.Thousands of lives are at risk. At a minimum, Congress and the Administration must fully fund PEPFAR at the authorized level of $48 billion through FY’13. Yet, President Obama’s global health initiative calls for just $63 billion over six years for all global health programs, including HIV. The proposed funding levels for global health programming are far below what is needed and the minimal requested increases for PEPFAR are a major setback for the millions of people living with HIV throughout the world. We can’t back down now. Our partners across the globe like Dr. Mugyenyi have devoted their careers and their lives to stopping the spread of HIV and they are counting on our continued leadership and support.

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