Picture: THINKSTOCK
Picture: THINKSTOCK

Multibillion-rand funding to SA from the US government’s flagship HIV/AIDS programme hangs in the balance as Washington prepares to usher in a new administration.

SA has been one of the biggest beneficiaries of the US President’s Emergency Plan For Aids Relief (Pepfar) programme, through which successive US administrations have pumped $5bn into the country since 2004, when the pandemic was at its height.

SA has a high HIV/AIDS burden, with an estimated
3.6-million South Africans on antiretroviral treatment.

US embassy spokeswoman Cynthia Harvey on Monday said: "In 2016, Pepfar contributed $410m towards combating HIV/AIDS and tuberculosis (TB) in SA."

Since 2004, the US has committed more than $5bn through Pepfar to South African health programmes.

In 2015 the US started the Dreams (Determined, Resilient, Empowered, AIDS-free, Mentored and Safe women) programme in SA.

The programme is a two-year, $66m commitment that focuses on alleviating the social drivers that contribute to more than 2,000 new infections a week among girls and young women in the country.

Make Inroads

SA also receives money from the Global Fund to Fight Aids, TB and Malaria.

But what will become of these initiatives, which have helped SA make inroads in its fight against the pandemic, under the new administration?

Harvey offers a restrained, diplomatic as well as pragmatic response to the question. "We’ve inherited many initiatives from prior Republican administrations — Pepfar, and African Growth and Opportunity Act.…

"We expect the next administration will inherit key initiatives from the Democratic Obama administration, too, such as Young African Leaders Initiative and Power Africa.

"So, while we do not yet know what president-elect Donald Trump’s foreign policy priorities will be, we feel optimistic that these important initiatives, including Pepfar, will continue to receive support," Harvey said.

Department of Health deputy director Yogan Pillay said not all donor funds flowed into state coffers, but that they also help to bankroll local nongovernmental organisations. Government spending on HIV/AIDS programmes has tripled since 2007-08. It is expected to average R913m over the medium term, according to projections in the national expenditure framework for 2010-16.

Treatment with antiretrovirals takes up a big portion of HIV/AIDS spending.

Far  From Ending 

"Accumulatively, we spend about R23bn per year [as a department]," said Pillay.

However, for Pillay, the fact that huge amounts of donor funds still come into the country indicates how far SA is from ending the epidemic.

The government has changed its policy to allow HIV-positive citizens to start treatment almost immediately as part of efforts to achieve the UN’s Sustainable Development Goals 4, which aim at eradicating HIV/AIDS by 2030. This means HIV-positive citizens do not have to wait until their immune defences crash before accessing free, government treatment.

The amended government threshold is set to a CD4 count of 500 cells/mm³, which will see more patients requiring first-line treatment faster.

First-line treatment, a term used for those who access anti-retroviral treatment for the first time, costs the state about R92 per patient, while second and third-line treatment sets the government back R300 and R1,000 per patient respectively.

The costs are projected to escalate year on year.

"Third-line treatment is more expensive because [patients are] … usually [on] drugs that are new and under patent," said the Treatment Action Campaign’s Maryjane Matsolo.

The government’s National Drug Policy of 1996 set out a roadmap to slash drug costs in the private and public sectors. The unintended consequence of this has been added pressure on manufacturers, who have little incentive to make drugs.

Government pricing interventions include regulation making it mandatory for manufacturers to offer cheaper, generic substitutions and a single exit price.

Industry has bemoaned the measures as anticompetitive.

The state aims to produce its own, cheaper drugs. In 2015, state-owned pharmaceutical company Ketlaphela was established. Operations at its plant will begin in 2019.

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