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PEPFAR and HIV Prevention

Posted March 20, 2008 at 2:09 PM

(This is the text of a video post we just made- if you prefer to watch rather than read, it's right here.)

Last month, Congress approved a five-year extension to PEPFAR- the President’s Emergency Plan For AIDS Relief. It allocates $50 billion over five years for international aid to help care for people living with HIV and for HIV prevention.

Great, huh?

Well… maybe not so great.

First off, there’s a lot of restrictions on what the money can be used for. Only 20% of it can be spent on prevention. Half of that can’t be used to fund anyone who promotes barrier methods like condoms. As for that last 10%, you can’t access it unless you can convince the fund managers that you have a ‘special case’ that makes condom advocacy appropriate.

What that means is you can only advocate for condom use if you’re dealing with ‘high risk’ groups. Like sex workers, for example. Except you can’t actually get PEPFAR funding if you’re working with sex workers. Oh, and no needle exchanges either, so that’s another ‘high risk’ group out of the picture.

And, of course, if you’re a family planning clinic that mentions the word ‘abortion’, you can’t get funding. We’re not talking about pro-life versus pro-choice. We’re talking about withholding HIV care, and that’s not smart if you want to end mother-to-child transmission.

(What’s funny is that PEPFAR officials couldn’t actually find enough organizations that met their criteria to actually spend the money on, so they had to bend their own rules.)

OK, so say your organization is committed to not working with sex workers, condoms, or abortion clinics, and you’re happy with the idea that anyone who does, doesn’t get the funding. $50 billion over five years. Great, huh?

Well… it depends on who gets the money, and what they do with it.

Botswana, for example, got $55 million in 2006. On the other hand, the ‘Partnership for Supply Chain Management’ – the US-based consortium which manages the supply of drugs to the recipient countries- got $82 million in 2006. (PEPFAR’s website doesn’t mention these administrative partners.)

75% of the money is for purchase of antiretroviral drugs. Now, that’s great, but the plan states that the drugs had to be ‘of the highest quality’ – which turns out to be shorthand for ‘FDA-approved’ – which turns out to be shorthand for ‘Made in the USA.’ So wait a minute. That $50 billion… $37.5 billion of it turns out to be going straight back into the US economy. Some of the countries we’re helping started buying generic drugs anyway, but a truly vast amount of US taxpayer’s money is still flowing right back to the drug companies.

Enough about PEPFAR. What’s happening in the USA? Well, the number of new infections is rising. The CDC is set to release figures that show that we’ve moved from 40,000 new infections a year to 60,000 new infections. As for the million plus people already living with HIV in the USA? We spent about $2 billion on them in 2006. That’s about $2,000 each. That’s about the cost of one month of antiretroviral drugs for one person.