U.S. government leading backlash against AIDS funding

Shannon Kowalski, Open Society Institute

A few weeks ago, the Boston Globe published an article on the U.S. government’s decision to flatline AIDS funding in countries that are currently receiving money through the President’s Emergency Plan for AIDS Relief (PEPFAR). [1] This flagship program has put 2.4 million people on treatment, restoring life and hope for millions.

Globally, more than four million people are currently receiving treatment, with support of PEPFAR, the Global Fund to Fight AIDS, Tuberculosis and Malaria, UNITAID, national governments, and other donors. But there are at least six million people who need treatment now, who are still unable to get it.

Instead of scaling up, the Obama Administration is now saying enough is enough. It is telling the health providers it funds, that they can only put new people on AIDS treatment if some of the people they are already treating die.

The Boston Globe article quotes Eric Goosby, the U.S. Global AIDS Coordinator, as saying “People are struggling to find resources to honor the commitments we have made… We’re not at a cap point yet. If it gets worse, we’ll have another discussion.”

Well, we just got our hands on a letter the U.S. government sent to treatment providers in Uganda in October, 2009. It says:

“In FY 2010 and 2011, each Partner should expect to have a set flat-lined budget for ARV procurement that should not be exceeded without discussion and written approval from their funding agencies. PEPFAR Implementing partners who directly provide antiretroviral treatment should only enroll new ART patients if they are sure that these new patients can continue to be supported without a future increase in funding…

“In filling treatment slots that are made empty through attrition – i.e. deaths and loss to follow-up estimated at 12-30% annually – priority should be given to the sickest patients, eligible pregnant women, children, TB/HIV patients, and family members of persons on ART. Partners should provide support as needed to ensure that patient information records are up to date and an equitable system of triage for total ART slots is worked out within their sites before enrolling any new patients.”

If that’s not a cap, then what is it?

Peter Mugyenyi, an AIDS specialist in Uganda, talked in that article about the anguish of turning people away: “Virtually every day, we have to turn away patients who need treatment, including breast-feeding women… We have to tell them ‘There is a freeze.’”

And at an event in DC on Monday as reported in the Science Speaks blog, Dr. Lydia Mungherera, a Ugandan medical doctor, activist, and woman living with HIV, said, “The hopelessness we had in the 1980s, when we had no treatment, is what we are going back to now… The basic issue of right to life is being disrupted.” [2]

Sources on the ground tell us that as many as 800 people are being turned away from clinics in Uganda a month, with no other option but to go home and hope that somebody else who is already on treatment dies before they do.

Treatment is one of the single most important HIV prevention tools that we have. Much, much more needs to be invested in better and more effective prevention programs. We know that treatment reduces infectivity and the availability of treatment encourages the uptake of voluntary HIV counseling and testing. According to an International AIDS Society briefing report Will We End the HIV Epidemic?, simply treating all of the people who need treatment now would decrease new infections by as much as a third. [3] When people know their HIV status, regardless of whether they are positive or negative, they are also more likely to take measures to protect themselves and others from HIV infection, whether that be by using condoms, reducing multiple partners, or not sharing needles.

Yet, the U.S. government’s decision to cap treatment is undermining the overall HIV/AIDS response in Uganda. As Mungherera put it: “Seventy percent of Ugandans don’t know their status. But what are we going to tell those people who come for testing? I’m sorry, there’s no treatment?”

The Boston Globe article made clear that it’s not just Uganda. The U.S. government has ordered a stop to building clinics in rural Mozambique and is starting to put limits on treatment in Zambia as well.

At the same time that the Obama Administration is flatlining PEPFAR funding, it is not doing anything more to make sure that it can leverage funding from other donors to help fill the gap. For every $1 that the United States gives to the Global Fund to Fight AIDS, Tuberculosis and Malaria, other donors give $2. Yet in its FY2011 budget, the Administration proposed to not just flatline, but cut, funding to the Global Fund as well.

Other donor governments appear willing and ready to follow the U.S. government’s lead.

Don’t let it happen. The International AIDS Society website where you can send a personalised email to President Obama and other G20 leaders, asking them to fully fund the Global Fund and keep their promise to universal access to AIDS treatment and prevention now.

Source: Open Society Institute Blog, (23 April 2010). gainst-aids-funding/


1. Stockman F. US seeks to rein in AIDS program. Boston Gobe. (11 April 2010). ton/articles/2010/04/11/us_seeks_to_rein_in_aids_program/?page=1

2. Mungherera L. A Unique Perspective on Flat-Funding From a Clinician, Activist, and HIV-Positive Woman. Science Speaks blog. (20 April 2010).


3. IAS Briefing Report: Will We End the HIV Epidemic?, March 2010. PDF download:

4. IAS website: Add your voice to the call for universal access. (Accessed May 2010).

Links to other websites are current at date of posting but not maintained.