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Funding threat to Uganda's winning AIDS program

From David McKenzie and Brent Swails, CNN
  • More than one million Ugandans are infected with HIV
  • U.S. funding has increased the number of Ugandans getting treatment
  • This year the rise in funding was the smallest in the program's history
  • Ugandan medics say they are turning away patients for the first time

Kampala, Uganda (CNN) -- An AIDS epidemic in Uganda has been made manageable by a U.S.-funded treatment program. But now Ugandan medics say they are having to turn away patients who need life-saving drugs.

In Uganda 1.1 million people are infected with HIV but the United Nations says significant progress has been made in recent of years in the treatment and care of people with HIV/AIDS.

That progress has largely been funded by PEPFAR -- the U.S. president's emergency plan for AIDS relief. In 2003 President George W. Bush pledged $7 billion a year for five years to be spent on prevention and treatment in the countries that needed it most.

This year PEPFAR funding increased by just over two percent -- the smallest rise since it's inception.

Dr. Peter Mugyenyi runs the Joint Clinical Research Center in Kampala, Uganda, which is almost entirely PEPFAR funded. It has become the largest provider of HIV/AIDS drugs in Africa -- a testament to PEPFAR's success.

Mugyenyi told CNN, "PEPFAR transformed this disease into a disease of hope, where patients would live a normal life. It reduced the number of orphans, it got people back to work."

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The U.N. says by 2008, about 141,000 Ugandans were receiving antiretroviral therapy. But Mugyenyi can recall a time when less than 10,000 of Uganda's HIV/AIDS sufferers were able to receive life-saving treatment.

Video: Fight over Uganda AIDS funding
Video: Uganda's fight against HIV
As people who saw the devastation of the past, we fear we may have a setback.
--Dr. Peter Mugenyi
  • Uganda
  • HIV and AIDS
  • Africa

"I once did a round, [when I had to] literally go around bodies of people lying in corridors to get to those on the bed," said Mugyenyi. "But that situation has been changed by PEPFAR."

But at one of the research center's outreach facilities -- Hope Clinic -- they're worried about funding.

In an internal memo dating from October 2009, obtained by CNN, the U.S. Centers for Disease Control and Prevention told Ugandan clinics like Hope they should "expect to have a set flat-lined budget for antiviral drug procurement."

Health workers at Hope Clinic say that means changes for clinics that in recent years have given free treatment to every patient who walked through the door.

Patients already enrolled in antiviral treatment continue to get their drugs, but now new patients go on a waiting list. A treatment slot opens when a patient dies. Mugyenyi said they turn away up to 20 patients every day.

"As people who saw the devastation of the past, we fear we may have a setback," he told CNN. "The achievements we have made over the years with PEPFAR -- we might begin to see a reversal of the benefits we have seen."

Dr. Eric Goosby, head of PEPFAR for U.S. President Barack Obama's administration, said the U.S. remains committed to helping those in need.

"It is regrettable that we don't have enough resources to pay for the unmet need anywhere -- in Uganda or anywhere on the planet," Goosby told CNN.

"We are not turning our backs to the unmet need. We have responded more than any other country to that unmet need and will continue to respond and do everything we can to find the resources to respond to those who still need these services."

In five years, PEPFAR has increased treatment by 95 percent in Uganda. But despite efforts, prevention has never taken hold.

Thirteen new Ugandans are infected with HIV every hour, meaning more and more demands for treatment. Experts say without better prevention, spending will become unsustainable.

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Meanwhile, the United States is calling on the Ugandan government to help fund treatment programs.

"We now need to look for help from the Ugandan government and from other entities to close that gap," said Goosby.

"Governments have to be ready to step up to that plate and orchestrate a triage mechanism that allows them to still treat the sickest before they treat those who can wait."

But the Ugandan government says it simply doesn't have the resources to do its part and is still reliant on outside funding.

Dr. David Apuuli, director general of the Uganda AIDS commission, told CNN: "I would find it strange that after a starting a program that was really praised then you suddenly -- knowing very well that this is the scenario -- you absolve yourself of this responsibility."

The U.S. government acknowledges that the global financial crisis has hurt funding prospects, but also points out the Obama administration's new $63 billion dollar global health initiative spreads U.S. support to more diseases. The focus is no longer just HIV/AIDS.

But all HIV+ Ugandans see is the struggle to get treatment. Ahmed Bukenya told CNN he is growing ever weaker. Just 43, AIDS has turned him into an old man.

He said he's tried for more than a year to get free drugs that could give him a normal life, but they can only tell him "no." For now, all the treatment slots are filled.

"I am desperate," Bukenya told CNN. "I see the change that the drugs have made in people's lives. I saw how people got better. It's just unfortunate that I came too late. I wish it would be resumed -- maybe then I could get better."