Govt wants to monitor PEPFAR funding

Hailed as a "quantum leap" in the global funding response to the HIV/AIDS pandemic, the US President's Emergency Plan for AIDS Relief (PEPFAR), has experienced its fair share of controversy. 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. But delegates attending this week's PEPFAR annual meeting for programme implementers in Durban, South Africa, are taking stock of the progress made by PEPFAR-funded projects and steering clear of controversy. PEPFAR is a US$15 billion initiative, launched by US President George W. Bush in 2003, for the prevention, treatment and care of HIV/AIDS in 12 African countries and the Caribbean. In a televised welcoming address, Bush noted that since its inception "the largest initiative in history to combat a specific disease" had supported services for the prevention of mother-to-child transmission of HIV to the benefit of about 4.5 million women, and had provided care to more than three million people. South Africa's health minister, Dr Manto Tshabalala-Msimang, pulled no punches during her speech at the welcoming ceremony, questioning the sustainability of PEPFAR and commenting on the "distortions created by external funding, especially when this is not aligned to national priorities". While acknowledging the critical contribution of donors, she stressed that "it is common knowledge that if you don't own the [funds], somebody will dictate the policy from outside". Tshabalala-Msimang also said external financing should be coordinated through official systems to prevent NGOs from "double dipping" by receiving funds from the government as well as from donors because of the authorities "not being able to know who is getting what". To ensure the "long-term sustainability and predictability" of HIV/AIDS programmes, the health minister called for countries to "progressively increase" national investment in the health sector. Acting US Global AIDS Coordinator Dr Mark Dybul told journalists PEPFAR was the first of a new commitment by the US government, which would continue beyond its five-year period. Other developed countries have still not come to the party in financing the pandemic. "The US is currently providing half of international funding towards AIDS ... which means that the US is providing as much as everyone else combined. This is a global epidemic, [needing] a global response, but we don't yet have that. Responding to criticism of the plan's perceived shift towards abstinence-based programmes, Dybul said PEPFAR had "equally emphasised" abstinence, fidelity and condom use in its prevention strategy.