Despite flat-funding for the U.S. President’s Emergency Plan for AIDS Relief, the U.S. is not retreating from its commitment to fighting AIDS, Eric Goosby said.
PEPFAR has pledged to provide antiretroviral treatment for more than 4 million people through 2013.
“That’s not a backing away,” the U.S. global AIDS coordinator told IRIN. “The backing away is a perception because of the drop in the funding trajectory compared to other years.”
The funding increase for PEPFAR was just 3 percent as the U.S. has been “heavily hit” by economic woes, Goosby said, adding that U.S. President Barack Obama has flat-funded or decreased funding for every government program except military and development initiatives.
Goosby said the U.S. is encouraging partner nations to allocate domestic financing to their own AIDS programs.
“We are telling our partners: ‘Here’s how much we’re putting in for the following functions, how much are you putting in?’” Goosby said. “We’re translating the human resources, the bricks and mortar, electricity or operational costs of a plant, into their costs as well as whatever resources they put into labs and drugs and procurement - countries do much of that. Once that baseline is established, we will hold an expectation that they maintain it and when they can, increase it, with specific percentages talked about.”
He, however, assured that the U.S. will not use “a population that we are currently caring for with drug support or care support or in our prevention activities as a leverage point to force a government.”
Despite PEPFAR’s funding woes, Goosby sees no major drop in patient treatment in the next couple of years.
“[W]e have enough fat in the system to redirect resources and get smarter at delivering services,” Goosby said.
The top U.S. AIDS envoy said the availability of co-trimoxazole – an antibiotic used to prevent HIV-related infections – and the earlier initiation of treatment and diagnosis of tuberculosis are contributing to PEPFAR cost-savings and helping to redirect resources toward treatment expansion.
The program is also making administrative changes. In procurement and distribution, for instance, PEPFAR has one administrator for 20 clinics rather than 20 separate administrators for each clinic, Goosby said.
“We have pretty much exhausted the move from brand [-name ARVs] to generics. We are more than 90 percent generic in PEPFAR-funded programmes. We need to get generics in second-line and we are a strong motor behind getting that straight,” he added.
Goosby also clarified that PEPFAR has not de-funded any program that provides treatment for sex workers.
“If there are examples of anybody being turned away [for being a sex worker], if someone feels that they were excluded from or dropped out of care for those reasons, we would get on that like a laser,” he said.