Five Republican U.S. senators recently sent a pointed letter to US Global AIDS Ambassador Eric Goosby, MD, asking for a clear response to reports that patients are being denied HIV therapy in Uganda and that clinicians elsewhere are “being forced to ration lifesaving treatment.”
The letter, signed by Sens. Michael Enzi of Wyoming, Tom Coburn of Oklahoma, and others, says the lawmakers are increasing concerned “that these reports signal a troubling direction of the current PEPFAR strategy.”
“…We acknowledge that prevention efforts are an important component of the highly successful PEPFAR program, but the clear innovation of PEPFAR is its focus on treatment,” the senators write. “After all, treatment is prevention. Reductions in viral loads reduce the likelihood of individuals spreading the disease. Treatment also reduces transmission among partners, diminishes mother-to-child transmission, and keeps those with HIV in the medical system where they can receive proper counseling. The availability of treatment is integral to promoting HIV/AIDS testing and early diagnosis. After all, how can we continue to promote testing when the program is not able to provide treatment?”
Click here to read a U.S. government memo directing Ugandan implementers not to add new patients unless a treatment slot opens due to a patient’s death or loss to follow up: Memo-Oct-Halt Treatment Scaleup
The GOP senators also note that in the reauthorization of PEPFAR, Congress specifically mandated that more than half of bilateral AIDS money be spent on lifesaving medical care for HIV positive patients and said they were concerned that the Office of the Global AIDS Coordinator might not be “taking adequate steps to meet these statutory requirements.”
They ask Dr. Goosby to answer a half-dozen or questions, including the total number of people expected to receive treatment in 2010; the treatment allocation, as a percentage of PEPFAR’s budget, in FY2009; and an explanation of PEPFAR’s policy on whether savings achieved in treatment programs can be used to further expand treatment slots.
That last item is particularly worrisome among some advocates who have heard that implementers are being told any cost-efficiencies they find in their treatment programs cannot be used to add patients to the rolls.
Another letter sent this week, from HIV advocates in the U.S. and Uganda to Secretary of State Hillary Clinton, also raises these issues.
“Hundreds of people each month are already going from clinic to clinic searching for treatment,” states that missive, from a coalition of advocacy groups including Physicians for Human Rights, Health GAP, and others. “Families are being forced to choose between dangerous resistance‐inducing sharing of drugs and letting family members die. Tens of thousands waiting in line for others to die are not ‘new’ patients, per se, but were tested and put into care through PEPFAR support with the promise that treatment would be available when clinically needed. Now they are instead being turned away. We note that while some implementers are enrolling new patients the extremely limited treatment slots available are far outstripped by demand.”
To read the letter for GOP Senators, click here: PEPFAR Treatment Letter
To read the advocates letter, click here: Clinton–UGANDA CS letter