(Washington, D.C.) — Last week it was announced that a dramatic cut in U.S. funding to South Africa’s HIV response will likely be reversed, so long as quality of services for people living with HIV is increased. The turnaround is a major victory for people living with HIV in the country, as critical resources will be restored. The planned funding cut had been prompted following poor performance in South Africa’s HIV program—where system failures have resulted in substantial numbers of people stopping life-saving and lifelong HIV treatment, at great risk to their own health.
“We are relieved the potential cut to funding has been averted—it risked derailing our national HIV response and ultimately harming people living with HIV,” said Anele Yawa, from the Treatment Action Campaign (TAC).
The announcement came during a second round of planning meetings held by the U.S President’s Emergency Fund for AIDS Relief (PEPFAR) in Washington, D.C. Now, with sustained performance improvements in the PEPFAR program, South Africa have the opportunity to receive up to US $730 million for the 2019/20 fiscal year.
The disappointing impact of South Africa’s HIV program, which was used to justify the proposed cuts, is not new information. In fact, in February 2018—recognizing the damage caused by several years of disinvestment as PEPFAR sought to transition out of South Africa—PEPFAR committed to an intensive “surge” (a new plan and injection of funds) to aggressively address the main drivers of the program’s poor performance. There were concerns that this plan didn’t work, but upon closer inspection activists learned that it was never actually implemented.
“Some of the ‘surge’ funds were committed to hire an additional 8,000 community healthcare workers—yet we now know that they were never hired and are only now being recruited,” said Lotti Rutter, from Health GAP. “Additionally the plan included a promise to hire 12,000 clinical and clinical support staff, including doctors and nurses. Yet more than one year later, less than 3,000 of these new staff have actually been hired. To improve impact it is crucial that PEPFAR uses this money to rapidly implement the agreed plan, including most critically increasing human resource capacity at the frontline of HIV service delivery in South Africa.”
“The South African government is also not doing enough,” continued Yawa. “The public healthcare system remains deeply dysfunctional and the HIV and TB response is being undermined by mismanaged and underfunded provincial healthcare systems and shortages of healthcare workers.”
For years now activists have been calling on the government to do more, faster, to address the crisis in the healthcare system. On some fronts the government is moving. The Department of Health, for instance, announced a slate of policy changes to remove barriers to care and to support accountability of health workers—but much more is needed.
Arguably the biggest challenge facing South Africa’s HIV response today is how to support many more people living with HIV to start and, importantly, stay on treatment. The reality is that 2.7 million people are not on treatment in the country—either never having known their HIV status, or more worryingly having started on treatment and then stopped. Addressing this major challenge, will require that PEPFAR intensify consultations with the South African government and people living with and affected by HIV to identify the root causes behind people disengaging from care and fund meaningful responses to address these.
“We call on PEPFAR to fund game-changing, evidence-based interventions—such as those outlined in the People’s COP—that give people the best chance to get on and stay on treatment,” said Vuyokazi Gonyela from SECTION27. “PEPFAR, the Global Fund, and government must all be held accountable for implementing high-quality programs and investing in interventions that help strengthen the weak health system. People with HIV deserve it.”
Médecins Sans Frontières
National Association of People Living with HIV and AIDS (NAPWA)
Positive Action Campaign
Positive Women’s Network
South African Network of Religious Leaders Living with or Personally Affected by HIV and AIDS (SANERELA+)
Treatment Action Campaign (TAC)
In January 2019 the U.S President’s Emergency Fund for AIDS Relief (PEPFAR) was threatening to cut the annual budget to South Africa’s HIV program by more than US $200 million or 30% (based on current funding levels). For more detail read this blog by Health GAP and TAC : South Africa: Cutting U.S. funding will harm people with HIV most.
The “People’s COP” outlines community priorities for PEPFAR’s Country Operational Plan 2019 (COP19). It was developed by a coalition of organisations including: Health GAP, Médecins Sans Frontières, the National Association of People Living with HIV and AIDS (NAPWA), Positive Action Campaign, Positive Women’s Network, the South African Network of Religious Leaders Living with or Personally Affected by HIV and AIDS (SANERELA+), SECTION27, and the Treatment Action Campaign (TAC)—and was finalized and endorsed at a National Summit of People Living with HIV.