OUtcry over stoppage oF AIDS funding

KAMPALA - A US decision to freeze spending on treatment for HIV in several African countries has prompted concern that some of the gains made against the Aids epidemic since 2003 could be reversed.

Former US president George Bush's Emergency Plan for Aids Relief (Pepfar), launched in 2003, focused largely on treating patients in urgent need of medicine, but the new US administration's programme has shifted away from emergency treatment.

"George W Bush is a hero in this country," said Peter Mugyenyi, who heads Uganda's Joint Clinical Research Centre, a leading Aids treatment clinic.

Uganda received $929million (R7,1billion) from Pepfar between 2003 to 2008 and used much of those funds to provide about 150000 people with antiretroviral therapy.

But the US switch in emphasis means that clinics are now being forced to turn new patients away.

"We had drugs under Pepfar. We didn't have to turn patients away," Mugyenyi said.

While Pepfar expanded access to medicine, new HIV infections rose. So, when Pepfar was up for renewal the new administration of President Barack Obama demanded greater focus on preventing new infections.

"We have all lost momentum on the prevention front and were paying for it now in the form of rising prevalence," Pepfar's Kampala-based spokesperson Lynne McDermott said.

The difficult economic climate meant spending more on prevention necessitated cutbacks on treatment in a country where the infection rate is 6,4percent in a population of 31million.

Patients who are already enrolled in a Pepfar programme will continue receiving free drugs, but most clinics have been told to stop acquiring new patients.

Mugyenyi accuses the US of breaking its promise to Uganda. "They have changed their programme very regrettably.

"The number one thing is availability of treatment. Any other programme, whatever name they call it, will fail."

Douglas Mugabi, a soft-spoken farmer who lives just outside Kampala, said he and his wife tested positive in 2003, and, when his health deteriorated in 2006, he began receiving free drugs.

Last year, his wife's condition also worsened.

"When I came in and we found out there was no longer a free programme I became cold," the 48-year-old said. "My wife is worried because the drugs are expensive, but according to our means, we couldn't support a life-long treatment."

Mugyenyi said many patients have similar stories.

"Pepfar promised them that if they need treatment they would get it.

"So the US should not say they are keeping their promise."

McDermott said the US cannot continue treating an ever-increasing number of patients and that unless new infections are reduced Ugandans will always be faced with drug shortages.

She noted that Pepfar continues to provide two thirds of all HIV-Aids money in Uganda, and urged Uganda "to identify other resources to fill the remaining gap".

Other resources are not readily available in Uganda, or elsewhere on the continent.

In a November report Doctors Without Borders detailed freezes on antiretroviral spending across Africa.

The report accused Pepfar of "reneging on promises made last year," but also apportioned part of the blame to the Global Fund, the public-private partnership which disburses extra funds to treat HIV-Aids, tuberculosis and malaria.

Eric Goemaere, an HIV specialist with Doctors Without Borders who has worked in several southern African nations, described the notion of spending more on prevention to slow the epidemic as a "fake argument".

He said any prevention strategy relies on people getting tested.

"Why were people getting tests? It is because treatment was available.

"If you look at the facts, it does not make any medical sense to cut back on treatment," he insisted.

Mugyenyi said he is panicking. "We are heading to carnage. Carnage which had been put to a stop.

"There is no prevention programme that can succeed without treatment." - Sapa-AFP