People gather around candles in the shape of a ribbon during an HIV/AIDS awareness campaign. Picture: REUTERS
People gather around candles in the shape of a ribbon during an HIV/AIDS awareness campaign. Picture: REUTERS

Health department officials have won a reprieve from the US government after it threatened to slash its funding for SA’s HIV/AIDS programmes due to poor performance.

Senior officials flew to Washington in late April, accompanied by civil society representatives, to ask the US President`s Emergency Fund for AIDS Relief (Pepfar) programme to reconsider its threat to cut support in its next funding cycle, which begins on October 1.  

While SA funds the lion’s share of its HIV/AIDS programmes, it receives substantial donor support. Its biggest international donor is Pepfar, which has provided $6.23bn since 2004.

In January, US Global AIDS co-ordinator Deborah Birx stunned officials when she threatened to cut funding from the current $670m to $400m for the 2019 US financial year, due to what she described as the “grossly suboptimal” performance of the Pepfar-supported programmes in SA. She drew particular attention to the fact that more patients had stopped treatment than had started in 2018, undermining efforts to bring SA’s HIV/AIDS epidemic under control. 

In the wake of her remarks, SA put measures in place to improve HIV patients’ retention in care and to encourage more people to get HIV tests, said Yogan Pillay, the health department's deputy director-general for communicable and noncommunicable diseases. Steps had also been taken to replace or improve underperforming implementing agencies which provide support to the government health facilities, he said.

The Washington discussions concluded with Pepfar agreeing to provide $400m in core funding for the next funding cycle, with an additional $330m contingent on better programme outcomes, he said. The funding was however conditional on US Congress approval, he said.

SA has the world’s biggest HIV/AIDS epidemic and aims to have at least 6.1-million people on treatment by December 2020. To reach this target, the health department needs to initiate about 1.6-million HIV positive people — many of whom do not yet know their status — on treatment, equivalent to about 89,000 new patients a month, said Pillay. The government is enrolling about 60,000 patients a month.

Pepfar was working closely with the department to develop a detailed plan to increase the number of people on treatment, and make sure they remained in care, he said.

“It puts the right kind of pressure on us to perform,” said Pillay.

Health minister Aaron Motsoaledi had written to provincial health MECs and heads of department, directing them to step up their oversight of HIV/AIDS programmes, and the national department had set up a “war room” to monitor data on HIV patients.

US health attaché to SA Steve Smith previously told Business Day that SA is one of seven countries that received letters from Birx raising concerns about their Pepfar-supported programmes.

“We all recognise the urgency of the need to get epidemic control and the need for resources, but we also need to make sure those resources are effectively spent,” he said in April.