Funding Decrease for HIV-Related Services

A recent study found a 33% drop in funding for a unit of the United States President’s Emergency Plan for AIDS Relief (PEPFAR) governance and systems unit, which supports infrastructure that provides HIV/AIDS services in low-income countries.

This organization helps pay for antiretroviral therapy, HIV testing, counseling, and other programs for people around the world, especially in countries that have been hit hard by the pandemic, such as sub-Saharan Africa.

The governance and systems unit of the program receives one-sixth of the total PEPFAR budget, according to a study published in Health Journal. Data was gathered from the PEPFAR Dashboards that provide information on funding.

Data showed that $33.3 billion was budgeted for PEPFAR between 2004 and 2014, according to the study. Only about $5.2 billion was allocated to governance and systems for those years, and their share of the budget dropped to 20.8% in 2014, after it was 27.5% in 2013.

Although the overall budget increased each year from 2004 to 2011, this specific unit of the program saw a slight decline from 2012 to 2013. The unit showed a 33% decline to $448.6 million from 2013 to 2014, but the overall budget decreased only 7% to $3.4 billion, the study found.

"People with HIV and AIDS who receive effective antiretroviral therapy can live for many years," said study lead researcher Corrina Moucheraud, MPH, ScD. "But the care and treatment of people with HIV and AIDS requires a strong health system, access to health workers, a reliable supply of medicines, laboratory testing and so on."

Researchers noted these findings allow the agency’s funding priorities to be reviewed for the first time.

"Programs like PEPFAR fund programs specific to HIV and AIDS, but to maximize their effectiveness and sustainability, they must also invest in strengthening health systems," Dr Moucheraud said. "This is especially true in resource-poor countries with weak health systems."

Though new HIV infections continue to decline, researchers said that organizations such as PEPFAR need to continue to receive full funding in order to keep that trend.

"These findings call into question whether the rhetoric of health systems strengthening has been translated into sustained policy action," the study concluded. "Additional research and analysis of the PEPFAR Dashboard data in coordination with in-depth country work is needed to fully understand the changing role of health systems in the operations of PEPFAR and other global health initiatives."