PEPFAR under the spotlight at national AIDS conference

The United States government made their presence felt at South Africa's second AIDS conference on Tuesday with a delegation led by US Ambassador to South Africa Jendayi Frazer presenting an overview of the local US response to the pandemic. South Africa is one of the beneficiaries of the US President's Emergency Plan for AIDS Relief (PEPFAR) - a US $15 billion programme launched by President George W Bush in 2003 to tackle HIV/AIDS in 12 African countries and the Caribbean region over five years. Many AIDS activists have criticised PEPFAR, regarding it as a slight to the Global Fund to fight AIDS, Tuberculosis and Malaria, set up in 2002. The US has committed $200-million a year to the Fund, which falls far short of its expected contribution. A third of PEPFAR's money goes to programmes promoting sexual abstinence, and prevention efforts aimed at promoting fidelity are also favoured. South Africa received almost $90 million from PEPFAR in fiscal 2004, and is expected to obtain another $149 million during the period from 1 October 2005 to 20 September 2006. About 12 percent of the $149 million will be given to the South African government, while 48 percent will go to local NGOs, universities and private partners. American and international NGOs, universities and private partners will receive 40 percent of the projected funds. During a satellite session before the official opening of the conference, being held in the east-coast city of Durban, representatives of the US Embassy confirmed that all PEPFAR funds allocated to South Africa in the current financial year had been disbursed, and noted that the US government had modified its bureaucratic procedures "so that the money could reach the field as quickly as possible." Gray Handley, health attaché of the US Embassy in Pretoria, said the lack of human and institutional capacity was of "central concern", as a large number of healthcare professionals had left South African, and some had even left the profession. Under PEPFAR, the US government had supported the training of 40,000 local healthcare professionals. Inadequate access to antiretroviral (ARV) treatment was another major problem, and more than 25,000 people had so far received ARV treatment (ART). Handley noted that during implementation of the programme, PEPFAR representatives discovered "that in resource-poor countries, adherence rates are higher than anywhere else in the world." Tuberculosis care had also been provided to 27,500 individuals. Currently in its second year of implementation, PEPFAR has given support and care to 72,000 orphans and vulnerable children. By September 2005, the US campaign hopes to be providing prevention of mother-to-child transmission services to 50,000 South African women, care to 110,000 orphans, and to have reached 40,000 people with tuberculosis treatment. Its goals for 2006 are even more ambitious. About 70,000 South Africans are expected to receive PEPFAR-funded ART, while 50,000 people should be able to access combined HIV and tuberculosis treatment. One of PEPFAR's most pressing objectives was to expand paediatric treatment, which Handley described as being "critically important" to the success of any AIDS relief programme. Nevertheless, Frazer stressed that "real results cannot be seen in statistics - they are [shown] in how people's lives have changed through the services provided". Although PEPFAR was originally designed as a five-year programme, Frazer reassured conference delegates that "we are not going to turn our backs" on South Africa after this period, and President Bush would re-evaluate the programme in 2008.