TUBERCULOSIS: Uganda: Aids financing limited

Kampala — Thousands of patients who are becoming clinically eligible for anti-retroviral treatment (ART) in Uganda risk early death unless an informal ban on enrollment of new patients by the ART treatment centres countrywide is lifted.
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Several organisations caring for people living with HIV/AIDS in Uganda have sounded alarm bells regarding their members who are being turned away at anti-retroviral treatment centres even when their CD4 counts (which determine patient immunity levels) show that they are due for treatment. An evening television news report on NTV Uganda on June 16 June, 2010 highlights the plight of hundreds of people with HIV/AIDS who are stranded at treatment centres which have declined to enroll them on treatment citing severe funding dilemmas for the lifelong ART drugs.
For people with HIV/AIDS, anti-retroviral treatment is the main hope of prolonging life. Anti retroviral drugs (ARVs) inhibit the ability of the HIV to multiply in the body.
Dr Peter Mugyenyi, the Executive Director of the Joint Clinical Research Centre (JCRC), one of the leading national providers of HIV/AIDS care and treatment in Uganda, acknowledges the problem.
"In Uganda, lower- than- anticipated funding support from PEPFAR and other donor entities in the past couple of years has forced many facilities to turn away new HIV-positive patients seeking ART," Dr Mugyenyi says in a foreword he wrote for the latest 2010 report of the International Treatment Preparedness Coalition (ITPC) entitled Rationing Funds, Risking Lives: World Backtracks on HIV Treatment.
Dr Deus Lukoye, the Kampala City Council HIV/AIDS Focal Person, has confirmed to this reporter that many ART sites in Kampala are turning away new patients due to donor funding deficits.
According to Prof. Michel Kazatchkine, Head of the Global Fund on AIDS, Malaria and TB, the United States President's Emergency Plan for AIDS Relief (PEPFAR) programme and the Global Fund together are providing almost 100% of the funding for ARV treatment costs in developing countries such as Uganda.
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In November 2009, a Medecins Sans Frontieres report indicated that the Global Fund was considering scaling down on HIV/AIDS funding despite the increasing demand. In the same report it is shown that the PEPFAR was planning to 'flat-fund' its programmes for the next two years hence reneging on promises made in the previous year to incrementally expand treatment funding. The global financial crisis and changing 'political climates' in donor countries are cited as the reasons for declining donor funding for anti retroviral treatment in Uganda.
The Uganda AIDS Commission in its March 2010 'UNGASS Country Progress Report' on anti retroviral treatment in the country says that 200,213 people are currently enrolled on anti- retroviral treatment which is about 51% of those in need. However 100,000 new patients are added to those in need of ART in Uganda each year, suggesting that the problem will only escalate going forward.
Dr Elizeus Rutebemberwa of Makerere University's School of Public Health projects that to enroll all clinically eligible patients on ART in Uganda, US$4 billion would be needed. Although this is a tall order, the recently announced budgetary allocations to other social sectors, other than health, by Finance Minister Syda Bbumba for the 2010/2011 financial year, suggests that Uganda has domestic financing capacity to, at least, significantly scale up access to ART treatment. However, current political priorities seem far away from such a move any time soon. Activists for anti-retroviral treatment in Uganda are advocating an initial budgetary allocation of 20 billion Uganda shillings.
"I can't believe the world will let me die when the money that is needed to put me on treatment and prolong my life, for my family's sake at least, is available globally and even in my own country" says James Mbidde (not real name), 38, who has been turned away at two ART centres in Kampala.
As it stands now, international donor funding for anti-retroviral treatment in Uganda and other developing countries is proving to be erratic and unsecured, in the long term, owing to the current global 'credit crunch' and changing political fortunes in western donor countries such as the United States.
All public health specialists interviewed for this report insist that Uganda has the internal fiscal capacity to scale up access to ART, a tragically brutal notion for James Mbidde to contend with.
Dr Mugyenyi, however, insists that "donor governments' inability or unwillingness to meet their commitments is one of the main reasons the ambitious- but certainly never irrationally unobtainable- goal of achieving universal access to HIV treatment by end of 2010 will not be met. The consequences are dire for the millions of people who have been able to access lifesaving treatment in recent years and the millions more in need."
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