Peter Mugyenyi runs the Joint Clinical Research Center (JCRC), one of the most successful AIDS-treatment providers in Uganda. Back in 2003, he went to Washington on a day’s notice to help the Bush administration draft its plan for what would become PEPFAR (the President’s Emergency Plan for AIDS Relief), the most ambitious public-health initiative ever to tackle the AIDS crisis, then sat beside Laura Bush at the State of the Union address when the program was announced. In the years since, he has been applauded when he exceeded his enrollment targets.
But today, despite treating 32,000 AIDS patients, he does not have a message of success. Instead, he was back in Washington in March, this time to warn that the stagnation of PEPFAR funding is beginning to “result in chaos.” At the beginning of April he was quoted in The Boston Globe, announcing that he had received word not to enroll new patients unless they are replacing others who have left or died. Midmonth, Health GAP, an independent activist organization, reported that antiretroviral-treatment programs at the JCRC and other clinics in Uganda were being “precipitously” transferred to government hospitals, which did not have the drugs to handle them. On Monday, Mugyenyi was again raising the alarm, having penned the introduction to a new report put out by the International Treatment Preparedness Coalition that warns of a global backslide in the AIDS fight.
Over the past year, the Obama administration has rolled out plans for a new, more pragmatic approach to U.S. global-health initiatives. As NEWSWEEK wrote in the fall, the plan was to get more results for less money, something health experts believed they could achieve by diversifying the U.S. global-health portfolio beyond the singular orientation of PEPFAR and teaming up with multilateral partnerships, like the Geneva-based Global Fund. This would allow HIV clinics to treat an array of health issues, including those not related to HIV, and stabilize funding for a variety of health concerns, independent of transitory fundraising pushes for the cause du jour. At the same time, driven by critiques of PEPFAR’s sustainability, the plan would cut costs by committing to treat the sickest patients first, shifting resources over to prevention efforts, and putting national governments on the hook for delivering services. The new plan isn’t chump change; Obama asked Congress for $63 billion for his new Global Health Initiative, to be spread out over the next six years. Still, the money previously authorized by Congress for PEPFAR ($48 billion over five years, approved in 2008) didn’t make it into this year’s budget. Instead, arguing for a smaller, smarter PEPFAR, the administration increased funding by just 2.2 percent this year, the smallest increase the program has seen since its inception.
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