The head of the US President’s Emergency Plan for Aids Relief (Pepfar) has assured SA and other recipient countries that it remains committed to the fight against HIV/Aids, despite the US Congress’ failure to reauthorise funding for another five years.
Pepfar was established by former Republican president George W Bush in 2003 to support the countries hardest hit by the HIV/Aids epidemic, including SA. It is the biggest foreign donor to SA’s HIV/Aids efforts, and currently provides slightly more than $450m a year.
“I remain hopeful that we will not walk away from our commitment ... and that the good work Pepfar has done, thanks to the extensive partnership in the countries we are working in, will speak for itself,” said US global HIV/Aids co-ordinator John Nkengasong on Tuesday.
In the past 20 years Pepfar had saved 25-million lives and prevented 5.5-million children from being born with HIV, he said in an online briefing ahead of World Aids day on December 1.
“This work cannot be stopped at this point. Pepfar is committed to working with countries to make sure we finish this fight, and make sure we celebrate the end of HIV/Aids as a public health threat by 2030,” said Nkengasong.
Pepfar was reauthorised with bipartisan support in 2008, 2013 and 2018, but this year a political row over abortion derailed the process. Congress failed to reauthorise the programme for another five-year term by September 30, the end of the US government’s fiscal year.
Pepfar is enshrined in US law, so the programme continues, but the failure to approve another five-year spending plan has created uncertainty for recipient countries such as SA, said Dave Clark, CEO of the Aurum Institute, one of Pepfar’s implementing partners in SA.
“Given that SA relies very heavily on Pepfar support, if it wasn’t reauthorised in the long run and was tailed off, it would be particularly worrying, especially at a time when we see the first signs of HIV prevalence declining in SA,” he said, referring to research released on Monday by the Human Sciences Research Council (HSRC).
HIV prevalence in SA fell from 14% in 2018 to 12.7% in 2022, according to preliminary findings from the sixth SA national HIV/Aids prevalence, incidence and behaviour survey, led by the HSRC.
Pepfar supports the government’s HIV/Aids programmes, and has played a key role in reaching key population groups that are particularly vulnerable to infection such as adolescent girls and young women, as well as helping to strengthen systems for tracking patients to ensure they remain on treatment, said Clark.
The UN Programme on HIV/Aids (UNAids) released a report on Tuesday calling on governments to ensure the communities most affected by HIV/Aids are at the forefront of efforts to prevent transmission and ensure treatment reaches those in need. It highlighted the work of activists and nonprofit organisations in SA, including the Treatment Action Campaign’s long battle to compel the government to provide HIV/Aids treatment and more recent work by Ritshidze, which monitors public health services. SA has the world’s highest HIV/Aids burden, with 7.8-million people living with the disease, according to the HSRC survey.
“Communities across the world have shown that they are ready, willing and able to lead the way. But they need the barriers obstructing their work to be pulled down, and they need to be properly resourced,” said Winnie Byanyima, executive director of UNAids.
“Too often, communities are treated by decisionmakers as problems to be managed, instead of being recognised and supported as leaders,” she said in a statement.
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