1. SATURDAY VISION
January 10, 2015 11INTERVIEW
Is it true that PEPFAR is changing
strategy on HIV response?
With the resources we have, we have been
supporting 80% of Uganda’s national HIV
response. But we are not going to be able
to do test and treat everywhere in Uganda.
We are looking at how we can support
the new UNAIDS 90-90-90 Approach in
specific geographic areas in Uganda. This
is where 90% of the population knows
their status, 90% of those who are positive
know they are positive, and 90% of those
who are positive have access to treatment.
With our available resources, we cannot
implement the 90-90-90 everywhere
in Uganda. So, over the next couple
of months, we are going to assess the
available data and select a few populations
in which we can implement the 90-90-90.
How will you choose the populations?
We will look at populations whose
prevalence is higher than the national
average and target the resources at those
areas. So, we won’t necessarily continue
to invest in low prevalence areas. We will
redirect resources into those populations
and areas where we have most of the virus.
So, over the next couple of months, we
will be looking at this data and trying to
make decisions about what that package
of districts and populations looks like.
There is a study, funded by the USAID and
done last year that looked at transmission
in critical hot spots. So, in urban areas,
it could be a market place, it could be a
place truck drivers stop, sex workers, fisher
folks, adolescent girls. The other two critical
populations are the uniformed personnel
and the prison populations who also tend
to have higher prevalence. We want to see
if we can start in 2016.
So, what will be the fate of patients
on treatment with PEPFAR support,
but who do not belong to these
populations you want to redirect
resources to?
We will keep supporting them. Anybody
receiving treatment from PEPFAR, will
be maintained in all the facilities that we
support. Yes, the funding has remained
levelled and we have to be more strategic
and focused, but we are not going to
abandon anyone who is currently on
treatment with PEPFAR support.
TheUSPresident’sEmergency
Plan for AIDS Relief (PEPFAR)
is celebrating 11 years of
operations in Uganda. The
Plan, which funds over 80%
of Uganda’s HIV response, is
changing strategy in 2016.
JOHN AGABA talked to
Sara Allinder, the country
coordinator, to find out what
this will mean to Ugandans.
Uganda needs its own dedicated
revenuestreamforfightingHIV
644,000
Ugandans are on
treatment, supported
in part by the US
government
directly
Will PEPFAR increase its funding to cater
for this maintenance package when the
new strategy starts implementation in
2016?
PEPFAR is generally approved and authorised
by the US Congress on five-year cycles. We are
in the middle of the third five-year cycle. But
our funding for each year is provided on an
annual basis. So, we only know year to year how
much we are getting. We don’t know what we
are getting in 2016. We are hoping it is at least
what we have received each year for the last five
years.
While celebrating 11 years of assisting
HIV response in Uganda, what are your
major achievements?
About 644, 000 Ugandans are on treatment,
supported in part by the US government either
directly where we provide the drugs or indirectly
by supporting health facilities or health workers
who provide the treatment.
More than 1.9 million sexually active males
have been provided with safe male circumcision.
Circumcision lowers risk of acquiring HIV by
about 60%. It also lowers the risk of passing
on HPV (that causes cervical cancer) to your
sexual partner. PEPFAR has also supported
counseling and testing services to nearly 34
million Ugandans.
You fund over 80% of Ugandas HIV re-
sponse, inject about $323m annually, but
HIV rates have kept high! Is there some-
thing not being done right?
We very much would like to see the numbers get
a lot lower. Uganda has the capacity to lower the
rates. However, there is good news; over the last
two years, we have seen dramatic improvements.
For the first time, in 2014, Uganda achieved the
tipping point, where more people were put on life
saving drugs (ARVs) than those acquiring HIV.
But, we have more to do. The number of new
infections needs to get down. We would like to
see it get to zero.
World Health Organisation guidelines
recommend treatment for persons with
HIV once their CD4 count drops to 500.
But, we are still at waiting for it to drop
to 350!
Ideally, everyone who tests positive should be
given treatment regardless of their CD 4 count.
Because when they are on treatment, they become
less infectious, reducing their chances of infecting
their sexual partners. However, treatment is
expensive.
The test and treat is beyond the amount
of available funding at the moment. It is
beyond the capacity of Uganda and its
donor partners. And even going to CD4
of 500 is beyond the envelope that is
available. The Uganda AIDS Commission
last year released a package of interventions
that are most needed, particularly targeting
pregnant women, paediatric patients and
key populations.
What is going to happen if the next
US President decided to re-focus his
priorities from PEPFAR?
I don’t know. Once you put someone on
treatment you have the moral obligation
to keep them on treatment. But, at the
same time, I have no expectation that
PEPFAR funding is going to increase or
even stay at that level year upon year
upon year. And so, it is important that we
use our opportunities to discuss with the
government what they can be doing to
increase their resources in support of the
HIV Trust Fund that was established in the
HIV Prevention and Control Act. And we
are going to see how we can support the
establishment of the fund in reality and also
in talking to government about how to use
the limited resources most effectively.
This year, we are going to fund a new HIV
impact assessment to evaluate how well
we have done. But, going by the estimated
incidences and estimated new infections
each year, we are seeing progress. The
responsibility for fighting HIV rests with
everybody at all levels. There are individual
choices that we make like condom use,
circumcision, or testing to know your status.
All of us need to carry this campaign of an
AIDS– free generation forward.
Any specific advice to the
Government?
Right now, PEPFAR alone has been funding
80% of the national response for the last
five years. This is not sustainable. According
to the new national strategic plan, Uganda
needs more than $800m to fully fund the
national response in 2016. PEPFAR and the
Global Fund are projected to offer about
only half of that amount.
Uganda needs to have its own dedicated
revenue stream for fighting HIV. It is
unreasonable to keep expecting PEPFAR
and the Global Fund to fund about 90%
of the $800m. Uganda, beyond facilities
and some of the health workers that
government provides, contributes only
about $50m a year.
Allinder, the country coordinator of PEPFAR, Uganda